Pulmonary Thromboembolism Patients Research Articles

Clinical Features and Risk Factors of 134 HA-PTE Patients

<i>Objective</i>: The objective of this study was to determine the clinical features and risk factors for hospital-associated pulmonary thromboembolism (HA-PTE) in Taizhou Hospital of Zhejiang Province. <i>Methods</i>: The clinical data of 513 pulmonary thromboembolism (PTE) patients who were admitted to Taizhou Hospital of Zhejiang Province in from January 1st, 2020, to December 31st, 2022, were retrospectively analyzed. The HA-PTE group and the community-associated PTE (CA-PTE) group were classified according to whether these disorders occurred during hospitalization or within a 90-day period of admission to the hospital (including inpatients with at least two days of hospitalization stay or a surgical procedure under or regional anesthesia). Differences in clinical features, risk factors and other indicators were also analyzed between the two groups. <i>Results</i>: A total of 513 patients with acute PTE were analyzed in the present study. Among them, 134 patients had HA-PTE, and 379 patients had CA-PTE. Patients in the HA-PTE group had less dyspnea or hemoptysis and more fever and chest pain. The all-cause mortality rate in the HA-PTE group was greater than that in the CA-PTE group, but it was not statistically significant. In comparison to community-acquired pulmonary thromboembolism (CA-PTE), long-term bed rest, active malignancy, lung infection, acute cerebral infarction, and fracture were observed as more prevalent risk factors in the hospital-acquired pulmonary thromboembolism (HA-PTE) group. Additionally, recent surgery (within one month post-operation) and central venous catheterization were identified as independent risk factors in the HA-PTE group. According to the subgroup analysis of the HA-PTE group, the all-cause mortality rate of patients who experienced HA-PTE in the hospital was lower than that of patients who experienced HA-PTE which in 90 days after admission (1.56% versus 2.85%, respectively); however, the difference was not statistically significant. <i>Conclusion</i>: More than half of the HA-PTE events were associated with recent hospitalization. HA-PTE and CA-PTE have different risk factors; when combined with different clinical symptoms, they have a higher incidence of HA-PTE occurring in the hospital. More attention should be given to inpatients to reduce the incidence of HA-PTE.

Inflammatory and Metabolic Predictors of Mortality in Pulmonary Thromboembolism: A Focus on the Triglyceride–Glucose Index and Pan-Immune Inflammation Value

Objectives: We aimed to evaluate the importance of metabolic and inflammatory markers, specifically the Triglyceride–Glucose Index (TGI) and pan-immune inflammation value (PIV), in predicting mortality among patients diagnosed with pulmonary thromboembolism (PTE). Materials and Methods: A total of 450 patients diagnosed with PTE between December 2018 and December 2023 were included in his study. The diagnosis of PTE was confirmed by clinical presentation, laboratory tests, and imaging studies such as computed tomography pulmonary angiography (CTPA). Data were obtained from medical records, including demographic information, medical history, laboratory results, and clinical outcomes. Results: In terms of age, non-survivors were older on average (66.1 ± 11.8 years) compared to survivors (58.3 ± 12.4 years) (p = 0.03). In terms of gender, 55% of non-survivors and 45% of survivors were male (p = 0.111). Non-survivors had higher BMIs (28.3 ± 5.1) than survivors (25.7 ± 4.5) (p = 0.04). In terms of hypertension, 40% of non-survivors and 30% of survivors had hypertension (p = 0.041). In terms of diabetes, 35% of those who did not survive and 20% of those who survived had diabetes (p = 0.001). In terms of smoking, 25% of non-survivors and 15% of survivors smoke (p = 0.022). In terms of TGI, non-survivors had higher TGI values (12.1 ± 1.5) than survivors (5.9 ± 1.2) (p < 0.001). In terms of PIV, non-survivors had significantly higher PIV (878.2 ± 85.4) than survivors (254.5 ± 61.1) (p < 0.001). The risk factors found to be significantly associated with differentiation in the multiple logistic regression analysis included age, BMI, TGI, and PIV (p = 0.005, p = 0.002, p = 0.013, and 0.022, respectively). As a result, according to ROC analysis for patients who are non-survivors, age, BMI, TGI, and PIV were significant prognostic factors. The cut-off points for these values were >60, >27, >10, and >500, respectively. Conclusions: the TGI and PIV are strong markers for predicting mortality in PTE patients. The independent predictive value of age and BMI further demonstrates their role in risk stratification. We think that high TGI values and PIVs reflect underlying metabolic and inflammatory disorders that may contribute to worse outcomes in these patients.

Characteristics of patients with symptomatic and incidental pulmonary thromboembolism.

Pulmonary thromboembolism (PTE) has a wide range of clinical presentations. With the advances in computed tomography (CT) technology and easier access to CT, the incidence of incidentally diagnosed cases of PTE has increased. The main aim of our study was to determine the frequency of patients incidentally diagnosed with PTE and whether these patients differ from patients with symptomatic PTE in terms of case characteristics. We retrospectively analysed the charts of 148 patients with PTE diagnosed and treated in 2022. Demographic characteristics, thrombus localisation, risk factors, and treatment modalities were compared between symptomatic patients with clinically suspected PTE and patients with incidentally diagnosed PTE by imaging methods performed for other purposes without clinically suspected PTE. Out of 148 patients with PTE, 42 (28.3%) were diagnosed incidentally. The rate of concomitant malignancy was significantly higher in patients with incidental PTE (54.8%) than in patients with symptomatic PTE (28.3%) (p < 0.01). There was no significant difference between symptomatic and incidental PTE patients in terms of the pulmonary artery segment in which the thrombus was located (p > 0.05). In our patient group, approximately one out of four patients diagnosed with PTE were incidentally diagnosed. Patients with malignancies may not have symptoms suspicious for PTE or their symptoms may go unrecognized.

Evaluation of neutrophil gelatinase-associated lipocalin (NGAL), hypoxia-induced factor-1 alpha (HIF-1α) and apelin 13 levels as new potential biomarkers for pulmonary thromboembolism: A prospective clinical study

AimThe objective was to evaluate the serum levels of neutrophil gelatinase-associated lipocalin (NGAL), hypoxia-induced factor-1 alpha (HIF-1α), and apelin 13 in patients with acute pulmonary thromboembolism (PE) and to investigate their diagnostic and prognostic role in PE patients with different mortality risk groups. Material and methodsThis study was conducted in a tertiary referral center and included 124 subjects with 94 cases of PE and 30 cases of healthy control group. All subjects were 18 years of age or older. The diagnosis of PE was done with computed tomography angiography of the thorax. After the diagnosis of acute PE, the serum levels of neutrophil gelatinase-associated lipocalin (NGAL), hypoxia-induced factor-1 alpha (HIF-1α), and apelin 13 levels were measured with a commercial enzyme-linked immunosorbent assay (ELISA) kit. ResultsThe median and IQR (interquartile range) age of patients and control groups were 68 (56–76) and 61.5 (56–67) years, respectively. The majority of patients with PE had risk factors (97.88 %), and only two (2.12 %) had no known risk factors. HIF-1 alpha level was found to be higher in the patient group than in the control group (p = 0.03). At the same time, the HIF-1 alpha level was found to be higher in the high mortality risk group than in the control group, low mortality risk group and intermediate-low mortality risk group (p = 0.000, 0.011, 0.002, respectively). While there was no significant difference in NGAL level between the patient group and the control group, a significant difference was observed between the mortality groups. NGAL level was found to be higher in the high mortality risk group than the control group, low mortality risk group, and medium-low mortality risk group (p = 0.001, 0.000, 0.010, respectively). Apelin 13 levels did not differ significantly in all groups. ConclusionHIF-1 alpha is a promising biomarker in distinguishing between patients and control groups and in identifying those with high mortality risk in the patient group. At the same time, NGAL can be used as a successful biomarker in determining the group with high mortality risk in cases of PE.

Lipid profile and mortality in patients with pulmonary thromboembolism; a systematic review and meta-analysis.

Acute pulmonary thromboembolism (PTE) is a life-threatening disease. Considering the availability and accessibility of assessing the serum lipids, this study aims todefine the predictive value of lipid profile, as well as the history of lipid disorders, for the mortality of PTE patients. Clinical studies, in which the relation of lipid profile, including triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and total cholesterol, as well as history of imbalance of lipids, with mortality of PTE patients was reported, were included. Non-English articles, reviews, letters, editorials, and non-English papers were excluded. A systematic search was conducted in PubMed, Embase, Scopus, and Web of Science databases. Therisk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal tools and CMA 4 was utilized forthe quantitative synthesis. Out of 3,724 records, six studies were included inthis systematic review. Lipid profile is suggested as a prognostic marker for survival in patients with PTE so higher initial serum HDL, LDL, and total cholesterol levels were associated with lower mortality rates in PTE patients. In addition, dyslipidemia was found to be associated withmortality of PTE patients. Based on the quantitative synthesis, there was a greater serum level of HDL in thesurvival group (standardized mean difference:-0.98; 95 %CI:-1.22 to-0.75; p-value<0.01). Mortality is lower in PTE patients with greater serum lipid levels; therefore, the early prognosis of PTE maybe ascertained by measuring serum lipids within the first 24 h of admission.

Federated-learning-based prognosis assessment model for acute pulmonary thromboembolism.

Acute pulmonary thromboembolism (PTE) is a common cardiovascular disease and recognizing low prognosis risk patients with PTE accurately is significant for clinical treatment. This study evaluated the value of federated learning (FL) technology in PTE prognosis risk assessment while ensuring the security of clinical data. A retrospective dataset consisted of PTE patients from 12 hospitals were collected, and 19 physical indicators of patients were included to train the FL-based prognosis assessment model to predict the 30-day death event. Firstly, multiple machine learning methods based on FL were compared to choose the superior model. And then performance of models trained on the independent (IID) and non-independent identical distributed(Non-IID) datasets was calculated and they were tested further on Real-world data. Besides, the optimal model was compared with pulmonary embolism severity index (PESI), simplified PESI (sPESI), Peking Union Medical College Hospital (PUMCH). The area under the receiver operating characteristic curve (AUC) of logistic regression(0.842) outperformed convolutional neural network (0.819) and multi layer perceptron (0.784). Under IID, AUC of model trained using FL(Fed) on the training, validation and test sets was 0.852 ± 0.002, 0.867 ± 0.012 and 0.829 ± 0.004. Under Real-world, AUC of Fed was 0.855 ± 0.005, 0.882 ± 0.003 and 0.835 ± 0.005. Under IID and Real-world, AUC of Fed surpassed centralization model(NonFed) (0.847 ± 0.001, 0.841 ± 0.001 and 0.811 ± 0.001). Under Non-IID, although AUC of Fed (0.846 ± 0.047) outperformed NonFed (0.841 ± 0.001) on validation set, it (0.821 ± 0.016 and 0.799 ± 0.031) slightly lagged behind NonFed (0.847 ± 0.001 and 0.811 ± 0.001) on the training and test sets. In practice, AUC of Fed (0.853, 0.884 and 0.842) outshone PESI (0.812, 0.789 and 0.791), sPESI (0.817, 0.770 and 0.786) and PUMCH(0.848, 0.814 and 0.832) on the training, validation and test sets. Additionally, Fed (0.842) exhibited higher AUC values across test sets compared to those trained directly on the clients (0.758, 0.801, 0.783, 0.741, 0.788). In this study, the FL based machine learning model demonstrated commendable efficacy on PTE prognostic risk prediction, rendering it well-suited for deployment in hospitals.

Chronic thromboembolic pulmonary hypertension in acute pulmonary embolism: a risk factor evaluation study

Aims: Pulmonary thromboembolism (PTE) is a highly mortal disease, defined by presence of thrombus partially or completely obstructing pulmonary arteries and/or veins, commonly originated from deep venous system. Chronic thrombroembolic pulmonary hypertension (CTEPH) is a rare complication of PTE with high mortality if not treated properly. In recent studies, incidence of CTEPH was found between %0,4-9,1. Due to clinically silent PTE in roughly %50 of patients, it is difficult to pinpoint the exact incidence of CTEPH. In this study, we aim to investigate PTE patients during their long-term follow up to observe CTEPH presence and evaluate CTEPH risk factors. Methods: Patients who had been evaluated in emergency service and/or admitted to pulmonary medicine ward between January 2014 and January 2017 with PTE diagnosis confirmed by computed tomography pulmonary angiogram (CTPA) were accepted retrospectively into the study. Their echocardiography, CTPA and lower extremity venous Doppler ultrasonography at 3., 6. and 12. months follow up were also included. In the patient group with pulmonary arterial pressure (PAP ) above 50 mmHg and residual thrombosis at CTPA, ventilation-perfusion scintigraphy had been performed and was added to the study. Among those suitable for CTEPH, right cardiac catheterization had been done to confirm the diagnosis and accepted as CTEPH. In addition to this group, patients who were not found suitable for right cardiac catheterization but wereclinically suitable for CTEPH are also included in the CTEPH group. Results: Average age of patients included into the study was 62(±16, 5), with 71 (%39) being male and 111 (%61) female. As for risk factors, 130 (%71,4) had acquired, 16 (%8,8) had genetic and the rest 36 (%19,8) did not have any prominent risk factors. At time of diagnosis, 10 patients were accepted as massive, 26 as sub massive and the rest 139 were considered non-massive PTE. Due to hemodynamic instability, 7 (%3,8) patients were given thrombolytic therapy. During 1 year follow-up, 5 (%2,7) patients were diagnosed with CTPH. When further investigation was performed on these 5 patients, atrial fibrillation (AF), persistent thrombosis at 12. month follow up CTPA and PAP above 55 mmHg upon time of diagnosis were found significant risk factors (p being 0,001/0,023/0,009 respectively). In multivariate analysis, no independent predictive factors were found in regards to CTEPH diagnosis. Conclusion: CTEPH is a preventable complication of PTE with severe mortality and morbidity if not properly treated. It might prove useful to utilize echocardiography and CTPA together, especially in those in high risk groups, for diagnosis of patients in early stage of CTEPH with no evident signs or symptoms.

Resveratrol as an adjuvant prebiotic therapy in the management of pulmonary thromboembolism.

Pulmonary thromboembolism (PTE) presents a grave threat to patient lives, often marked by arterial occlusion in the pulmonary vasculature, frequently stemming from deep vein thrombosis (DVT). While current anticoagulant therapies offer temporary relief, they fall short of addressing the long-term management of PTE. Notably, PTE-associated mortality rates continue to rise annually, positioning it as a crucial concern within the cardiovascular landscape. An intriguing suspect underlying compromised prognoses is the intricate interplay between the gut microbiome and PTE outcomes. The gut-derived metabolite, trimethylamine N-oxide (TMAO), has emerged as a direct contributor to accelerated thrombogenesis, thereby heightening PTE susceptibility. In pursuit of remedies, research has delved into diverse prebiotic and probiotic interventions, with Resveratrol (RSV) emerging as a promising candidate. This paper explores the potential of RSV, a polyphenolic compound, as an adjuvant prebiotic therapy. The proposed therapeutic approach not only augments anticoagulant potency through strategic pharmacokinetic interactions but also introduces a novel avenue for attenuating future PTE incidents through deliberate gut microbiome modulation. RSV's multifaceted attributes extend beyond its role in PTE prevention. Recognized for its anti-inflammatory, antioxidant, and cardioprotective properties, RSV stands as a versatile therapeutic candidate. It exhibits the ability to curtail platelet aggregation, augment warfarin bioavailability, and mitigate pulmonary arterial wall thickening - an ensemble of effects that substantiate its potential as an adjunct prebiotic for PTE patients. This literature review weaves together the latest insights, culminating in a compelling proposition: RSV is an instrumental player in the trajectory of PTE management.

Prospective analysis of pre and postoperative laboratory parameters associated with thrombosis in patients with ovarian cancer.

Patients with ovarian cancer have a high risk of developing thrombosis. We aimed to investigate pre and post operative biomarkers associated with thrombosis including deep vein thrombosis and pulmonary thromboembolism in patients treated for ovarian cancer. We collected pre and post operative blood samples from 133 patients undergoing surgery for ovarian cancer between December 2021 and August 2022. The measured parameters were white blood cell count, hemoglobin, platelets, monocytes, serum glucose, CA125, D-dimer, fibrinogen, prothrombin time, activated partial thromboplastin time, fibrinogen degradation products, antithrombin III, protein C, protein S, plasminogen, plasminogen activator inhibitor 1, homocysteine, N-terminal pro-brain natriuretic peptide, interleukin 6, thrombopoietin, soluble P-selectin and granulocyte stimulating factor. Body mass index of patients were collected. Differences between patients who developed thrombosis and those without were compared with Wilcoxon rank-sum test and we analyzed the continuous variables using logistic regression. Twenty-one (15.8%) patients developed thrombosis ranging from 6 to 146 days (median 15 days) after surgery. Pre operative values of homocysteine (p = 0.033) and IL-6 (p = 0.043) were significantly increased and post operative aPTT (p = 0.022) was prolonged and plasminogen (p = 0.041) was decreased in patients with thrombosis. It is important to find novel biomarkers for thrombosis to carefully manage patients who are prone to develop thrombosis despite preventive measures were applied.

Pulmonary embolism - Pulmonary thromboembolism in patient with rectal adenocarcinoma

Pulmonary embolism - Pulmonary thromboembolism in patient with rectal adenocarcinoma

Evaluation of right ventricle functions in acute pulmonary thromboembolism using tissue doppler imaging

Aims: Right ventricular (RV) systolic and diastolic functions are impaired in a significant proportion of patients with acute pulmonary thromboembolism (PTE). In these cases, knowledge of RV function is of great importance both in the diagnosis and in the choice of treatment. Our aim was to evaluate RV systolic and diastolic functions by standard pulse Doppler and tissue Doppler imaging (TDI) in normotensive patients with PTE without hemodynamic disturbances. Methods: A total of 48 subjects, including 28 acute PTE patients (14 M, 14 F) with a mean age of 41 ± 13 years and 20 healthy subjects (10 M, 10 F) with a mean age of 40 ± 9 years, were included in our study. At the level of the tricuspid and mitral valve cusps, pulse Doppler echocardiography evaluated diastolic filling parameters. With the TDI technique, the diastolic function of the RV lateral wall and septum were analyzed in segments in the apical four-cavity image. Diastolic early and late velocities (e', a'), e'/a' ratio, e'dt, isovolumetric relaxation time (IVRT), systolic velocity (s'), and systolic duration (s' duration) were evaluated by TDI. Results: Among the RV standard Doppler parameters, a significant decrease in E velocity and E/A ratio and a significant increase in A velocity were observed compared to the control group (p=0.042; p=0.002; p=0.001, respectively). A non-significant prolongation in E’dt was detected. RV ejection fraction was significantly lower in PTE patients compared to the control group (51.1% vs. 69.7%) (p=0.001). TDI was used to look at the RV systolic function, and it was found that all segments had higher systolic (Sa-m) velocities than the control group. However, systolic velocities in patients with DHB in the RV were found to be lower in the annular regions and RV-free wall. Increased s' velocities were observed in annular regions and RV-free walls. However, no statistical significance was found in s' velocity values. Conclusion: RV systolic and diastolic functions may be impaired in normotensive patients with PTE without hemodynamic disturbances.

Pulmonary Thromboembolism in Multidrug-Resistant Tuberculosis: A Case Series Highlighting the Importance of Early Diagnosis and Management

Background: Pulmonary tuberculosis (PTB) is an established cause of arterial and venous thrombosis. With the rising incidence of multidrug-resistant tuberculosis (MDR TB), which has a prolonged treatment course, pulmonary thromboembolism in such cases further complicates the treatment outcome in terms of mortality and morbidity. TB causes systemic hypercoagulability, which may lead to both arterial and venous thrombosis. Therefore, it is important for treating physicians to be aware of the entity and have a sharp watch for the development of Pulmonary thromboembolism in cases of MDR TB. The Case: We present the association of pulmonary thromboembolism (PTE) with MDR TB in three young males who developed pulmonary thromboembolism during the treatment of MDR TB, along with their management using anticoagulant agents. Conclusion: PTE in cases of TB is rare but fatal. High suspicion of PTE in patients with MDR TB will help in diagnosing the dreaded condition early and aid in reducing preventable mortality with PTE. Early recognition, prompt diagnosis, and management is the key to saving the lives of those with this fatal complication.

The relationship between echocardiographic parameters and albumin bilirubin score in patients with acute pulmonary thromboembolism.

The Albumin-Bilirubin (ALBI) score is useful and easy-to-use for objectively assessing liver function. We investigated whether the ALBI score, a parameter indicating liver stiffness, congestion and fibrosis, has any relationship with echocardiographic parameters in patients with acute pulmonary thromboembolism (PTE). A total of 140 patients diagnosed with acute PTE were retrospectively analyzed. These patients were divided into three groups according to the hemodynamic severity of acute PTE: Group I [Low risk]; Group II [Submassive or intermediate-risk]; and Group III [Massive or high-risk]. Biochemical data obtained from venous blood samples taken at admission were analyzed. In addition, data were also analyzed from transthoracic echocardiography and pulmonary computed tomographic angiography performed at admission. ALBI, Bova, and PESI scores were calculated. ALBI scores (-3.32 ± 0.21 vs -2.86 ± 0.15 vs -2.46 ± 0.2, p < .001) were statistically significantly higher in Group III than Groups I and II. There was a significant difference between the three groups in terms of echocardiographic parameters, and LVEF and TAPSE values tended to decrease from group I to group III. In multivariate linear regression analysis, sPAP, RV/RA diameter, and NT-pro-BNP were found to be significantly associated with the ALBI score. An ALBI score higher than -2.87 was associated with Bova stage II-III in patients with Group I and Group II PTE, with a sensitivity of 87% and a specificity of 62% (AUC = 0.804; 95% CI 0.713-0.895; p < .001). The ALBI score, which is a common, easy-to-use, and inexpensive method, may be beneficial to select intermediate and high-risk patients in patients with acute PTE. Additionally, it may have prognostic value in distinguishing low and intermediate-risk acute PTE patients.

Incidence of pulmonary thromboembolism in patients who underwent CT pulmonary angiography in the first quarter of 2023 at CHC Rijeka

Cilj: Plućna tromboembolija (PTE) je hitno medicinsko stanje kod kojeg dolazi do okluzije jedne ili više grana plućnih arterija tromboembolusom. CT plućna angiografija (CTPA) je brza, neinvazivna radiološka metoda kojom se postavlja dijagnoza PTE. Glavni cilj ovog rada je odrediti incidenciju pozitivnih PTE nalaza kod 524 pacijenta podvrgnutih CTPA te odrediti učestalost zahvaćenih grana plućnih arterija. Nadalje, jedan od ciljeva je i odrediti incidenciju usputnih nalaza (plućni nodusi, tumor pluća, pneumonija, infarkt pluća, pleuralni izljev). Ispitanici i metode: U ovom retrospektivnom istraživanju prikupljeni su podaci 524 bolesnika koji su zbog sumnje na PTE podvrgnuti CTPA pregledu na Kliničkom zavodu za dijagnostičku i intervencijsku radiologiju, na lokalitetu Sušak, u Kliničkom bolničkom centru (KBC) Rijeka, u razdoblju od siječnja do travnja 2023. godine. Svi potrebni podaci navedeni u nalazu radiologa prikupljeni su iz integriranog bolničkog informacijskog sustava (IBIS) i pripadajuće aplikacije (ISSA). Rezultati: Od ukupno 524 bolesnika podvrgnutih CTPA, PTE je dokazana kod 97 ili 18,51% pacijenata. U našem istraživanju bio je podjednak broj ispitanika muškog i ženskog spola (260 ili 49,62% naprema 264 ili 50,39%). Nešto je veća incidencija PTE bila kod muškaraca (52 ili 53,61%) nego kod žena (45 ili 46,39%). Najveći broj bolesnika (262 ili 50,00%) pripadao je dobnom razredu između 61. i 80. godine života. Usputni nalazi opisani na CTPA, prema redoslijedu učestalosti su bili: pneumonije (37,15%), pleuralni izljevi (34,86%), plućni nodusi (16,79%), tumori pluća (6,87%) i plućni infarkti (4,33%). Zaključak: CT plućna angiografija predstavlja zlatni standard za detekciju plućne tromboembolije. Pregledom dostupne literature, incidencija PTE je komparabilna s rezultatima našeg istraživanja. U našoj, kao i u većini recentnih studija, PTE je najčešće detektirana u segmentalnim i subsegmentalnim granama plućnih arterija, dok se incidencija usputnih nalaza detektiranih na CTPA ne podudara s rezultatima drugih istraživanja.

Algorithms of Electrocardiographic Changes for Quantitative and Localization Analysis of Thrombus Burden in Patients with Acute Pulmonary Thromboembolism.

Various electrocardiographic (ECG) abnormalities are associated with the severity of pulmonary thromboembolism (PTE). The utility of evaluating the clot burden of PTE based on ECG findings alone has yet to be thoroughly investigated in Chinese patients. The aim of this study was therefore to use ECG signs to establish novel models for quantitative and localization analysis of clot burden in patients with acute PTE. Acute PTE patients from three centers were enrolled between 2015 and 2019 in a retrospective cohort study (NCT03802929). We analyzed the 12-lead ECGs at admission and studied computed tomography pulmonary angiography (CTPA) features to obtain the Qanadli score of clot burden and location of thrombus. Novel risk prediction models were developed and validated using derivation and external validation cohorts, respectively. A total of 341 acute PTE patients were screened, of whom 246 (72.1%) were from Shanghai Tenth People's Hospital, 71 (20.8%) were from Shanghai Pulmonary Hospital and 24 (7.0%) were from Qidong People's Hospital. In the derivation cohort, predictors included in the final models were congestive heart failure, chronic obstructive pulmonary disease, hypertension, coronary heart disease, atrial fibrillation and ECG abnormalities. The CHARIS (COPD/CHF/CHD, HTN, Atrial arrhythmias/AF, RBBB/RAD, Inverted T wave and S1Q3T3/ Sinus tachycardia) I model was established for quantitatively assessing Qanadli score. It had moderate discrimination in both the derivation cohort (concordance index (c-index) of 0.720, 95% CI 0.655-0.780) and the validation cohort (c-index of 0.663, 95% CI 0.559-0.757). The CHARIS II model was used to predict the probability of trunk obstruction. It showed similar discrimination in the derivation cohort (c-index of 0.753, 95% CI 0.691-0.811) and in the validation cohort (c-index of 0.741, 95% CI 0.641-0.827). Calibration curves and Hosmer-Lemeshow test confirmed the accuracy of the risk prediction equations in the external validation dataset. Decision curve analysis showed the CHARIS I and CHARIS II algorithms had positive net benefits in both the derivation and validation cohorts. From quantitative and localization perspectives, the CHARIS algorithms can identify acute PTE patients with heavy thrombus burdens prior to imaging diagnosis. NCT03802929, https://www.clinicaltrials.gov/study/NCT03802929.

Correlation between the preoperative maximum soleal vein diameter and the postoperative bilateral deep venous thrombosis in THA: a case-control study.

Patients with bilateral lower limb deep venous thrombosis (DVT) have a higher risk of pulmonary thromboembolism (PTE) and mortality than patients with unilateral lower limb DVT. Preoperative dilatation of the soleal vein (SV) diameter is a predictor of postoperative DVT. The purpose of this study is to investigate the cutoff value for SV diameter as a risk factor for VTE development. The authors examined 274 patients with unilateral THA who met the inclusion criteria in a retrospective study. The mean age of the patients was 65.7±11.2 years, with 70 males and 204 females. Bilateral lower limb vein ultrasonography was performed preoperatively and ~1 week after THA. The frequency and localization of DVT were investigated in postoperative ultrasonography. The patients were divided into three groups: no DVT (non-DVT), unilateral lower limb DVT (Uni-DVT), and bilateral lower limb DVT (Bi-DVT). The three groups were compared in terms of preoperative venous vessel maximum diameter. There were 62 patients (22.6%) who had postoperative DVT. There are no symptomatic PTE patients. DVT was found in 44 patients (16.0%) of the Uni-DVT group and 18 patients (6.6%) of the Bi-DVT group. The SV maximum diameter was 6.41±1.79mm in the non-DVT group, 7.06±2.13mm in the Uni-DVT group, and 8.06±2.26mm in the Bi-DVT group, with a significant difference (P=0.001) between the non-DVT and Bi-DVT groups. In the Bi-DVT group, the cutoff value for preoperative SV maximum diameter was 6.75mm (95% CI: 0.625-0.831; P=0.001; sensitivity, 77.8%; specificity, 60.4%; area under the curve, 0.728). In THA, preoperative ultrasonography with a maximum SV diameter of 6.75mm or greater was the risk of bilateral DVT leading to fatal PTE is increased.

Incidence and risk factors of deep vein thrombosis and pulmonary thromboembolism after spinal cord disease at a rehabilitation unit: a retrospective study.

Deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) are major complications of spinal cord disease. However, studies of their incidence in Korean patients are limited. Thus, this study investigated the incidence and risk factors of DVT and PTE in Korean patients with spinal cord disease. We retrospectively analyzed the medical records of 271 patients with spinal cord disease who were admitted to a rehabilitation unit within 3 months of disease onset at a tertiary hospital. The presence of DVT and PTE was mainly determined using Doppler ultrasonography and chest embolism computed tomography. Risk factor analysis included variables such as sex, age, obesity, completeness of motor paralysis, neurological level of injury, cause of injury, lower extremity fracture, active cancer, and functional ambulation category (FAC) score. The incidences of DVT and PTE in the patients with spinal cord disease were both 6.3%. Risk factor analysis revealed that age of ≥65 years (p=0.031) and FAC score of ≤1 (p=0.023) were significantly associated with DVT development. Traumatic cause of injury (p=0.028) and DVT (p<0.001) were significant risk factors of PTE. Patients with spinal cord disease developed DVT and PTE within 3 months of disease onset with incidence rates of 6.3% and 6.3%, respectively. Age of ≥65 years and an FAC of score ≤1 were risk factors for DVT. Traumatic cause of injury and DVT were risk factors for PTE. However, given the inconsistent results of previous studies, the risk factors for DVT and PTE remain inconclusive. Therefore, early screening for DVT and PTE should be performed in patients with acute-to-subacute spinal cord disease regardless of the presence or absence of these risk factors.

Pulmonary Thromboembolism in Covid-19 Pneumonia: A Case Series and Update

BACKGROUND: COVID-19 is associated with lots of complications. Pulmonary thromboembolism is a rare complication of pneumonia that is showing a rising trend in the context of COVID-19. CASE PRESENTATION: We present the CTPA findings in 3 patients of pulmonary thromboembolism in patients with COVID-19 pneumonia. The patients had varying involvement of pulmonary arteries. We also provide and update on the published literature on covid pulmonary embolism in 2023. CONCLUSIONS: Pulmonary embolism can complicate Covid-19 pneumonia and lead to poorer prognosis. Hence, the correct diagnosis is imperative as prompt antithrombotic therapy can significantly reduce mortality and morbidity. There have been updates on pulmonary embolism in Covid-19 patients especially in late 2022 to early 2023 and they have been presented in this study.

Multiple sclerosis and the incidence of venous thromboembolism: a systematic review and meta-analysis.

A number of studies have suggested that multiple sclerosis (MS) can be associated with serious vascular complications, for which pulmonary thromboembolism (PTE) is a potentially lethal complication. The purpose of this study is to establish a current literature-based estimate of the incidence of venous thromboembolism (VTE), deep vein thrombosis (DVT), and PTE in patients with MS (pwMS) due to the lack of systematic reviews and meta-analyses on this topic. In this systematic review and meta-analysis, studies were assessed regarding the association between MS and the incidence of VTE. The studies were identified through a systematic search of major electronic databases spanning the period from 1950 to February 2022. A random-effects analysis was conducted to calculate the pooled effect size (ES) and 95% confidence intervals (CI) using STATA software. Nine out of 4605 studies were included in the meta-analysis, with an overall sample size of 158,546 individuals. Meta-analysis revealed that the pooled incidence of VTE was 1.8% (95% CI 1.4-2.3) among pwMS. Also, there was an incidence of 0.9% (95% CI 0.4-1.4) and 1.5% (95% CI 1-2.2) for PTE and DVT, respectively in pwMS. Analysis showed MS would be significantly associated with a twofold increased risk of VTE [risk ratios (RR) = 2.12 (95% CI 1.53-2.93)]. Although MS is not typically considered a major risk factor for VTE, the meta-analysis of cohort studies shows that MS has a relative association with an increased incidence of VTE. Future research should focus on the investigation of the effects of MS and its treatments on VTE risk, and also a full range of confounding adjustments will be needed.

A Scoring System to Determine the Risk Factors Causing Recurrent Pulmonary Thromboembolism.

The risk of recurrence in pulmonary embolism is the highest in the first week after the acute event. Although it decreases over time, it may remain high for months depending on compliance with treatment and the nature of the underlying risk factor. Our study aimed to identify risk factors that lead to recurrence in pulmonary thromboembolism (PTE) patients and establish an easy-to-use scoring system that determines the risk of recurrence after the first embolism. We retrospectively evaluated 1452 patients who were diagnosed with acute PTE between 7/1/2014 and 7/1/2019. Demographic data, comorbidities and clinical data of the patients, and risk factors were recorded. The relationship of the examined parameters with recurrent PTE was evaluated. Diabetes mellitus (DM), hypertension, obesity, and the presence of at least one hereditary risk factor were found to be associated with recurrence. The sensitivity of our score was 66.9%, the specificity was 63.2%, the positive predictive value was 19%, and the negative predictive value was 93.7%. The risk of recurrence in the patients identified as high-risk in the scoring system was 3.47 times higher than those identified as low-risk. In terms of risk of recurrence, special attention should be paid to patients with diabetes, HT, obesity and any of the hereditary risk factors. Using scoring systems to determine the risk of recurrence will be valuable and interesting as it is easy-to-use, gives quick results and provides quantitative results.