Prevalence Of Acute Pulmonary Embolism Research Articles

Correlation of Air Pollution and Prevalence of Acute Pulmonary Embolism in Northern Thailand.

Background: The relationship between the level of air pollution and acute pulmonary embolism (APE) has had inconsistent results. Objective: This study aimed to analyze the relationship between the high level of air pollution exposure and APE. Methods: A ten-year retrospective cohort, single-center study was performed on patients diagnosed with APE from October 2010 to December 2020. The association between air pollution and monthly APE case diagnosis was analyzed. Results: A total number of 696 patients was included. The effect of every 10 µg/m3 increment of particulate matters with an aerodynamic diameter < 10 µm (PM10) on total monthly APE cases (unprovoked PE and provoked PE) was increased significantly at lag 4, 5 and 6 months with adjusted RR (95% CI) of 1.06 (1.01, 1.12), p = 0.011, 1.07 (1.01, 1.13), p = 0.021 and 1.06 (1.01, 1.12), p = 0.030, respectively. Adjusted RR for APE was significantly increased for PM10 in the second tertile ((adjusted RR (95% CI) 1.76 (1.12, 2.77)), p = 0.014. Conclusions: We conclude that PM10 is associated with an increased prevalence of APE cases. The policy for tighter control of air pollution in our country is needed to reduce the impact of air pollutants on people’s health.

Prevalence of Acute Pulmonary Embolism at Autopsy in Patients With COVID-19

To date, the actual prevalence of acute pulmonary embolism (PE) in patients with SARS-CoV-2 infection remains unknown, as systematic screening for PE is cumbersome. We performed a systematic review and meta-analysis on autoptic data to estimate the prevalence of histopathologic findings of acute PE and its relevance as a cause of death on patients with COVID-19. We searched MEDLINE-PubMed and Scopus to locate all articles published in the English language, up to August 10, 2021, reporting the autoptic prevalence of acute PE and evaluating PE as the underlying cause of death in patients with COVID-19. The pooled prevalence for both outcomes was calculated using a random-effects model and presenting the related 95% confidence interval (CI). Statistical heterogeneity was measured using the Higgins I2 statistic. We analyzed autoptic data of 749 patients with COVID-19 (mean age 63.4 years) included in 14 studies. In 10 studies, based on 526 subjects (mean age 63.8 years), a random-effect model revealed that autoptic acute PE findings were present in 27.5% of cases (95% CI 15.0 to 45.0%, I2 89.9%). Conversely, in 429 COVID-19 subjects (mean age 64.0 years) enrolled in 9 studies, acute PE was the underlying cause of death in 19.9% of cases (95% CI 11.0 to 33.3%, I2 83.3%). Autoptic findings of acute PE in patients with COVID-19 are present in about 30% of subjects, whereas a venous thromboembolic event represents the underlying cause of death in about 1 of 4 patients.

Acute pulmonary embolism and COVID-19 pneumonia: A multicenter case-control study

BackgroundSeveral studies have described hypercoagulability and high incidence of thromboembolic events in COVID-19 patients. We aimed to evaluate the prevalence of acute pulmonary embolism [APE] and to explore which factors were associated with APE in COVID-19 patients. We propose an algorithm for the management of anticoagulation therapy.MethodsThis study is an observational retrospective multicenter study which include all consecutive patients with a diagnosis of COVID-19 and who experienced a diagnosis of APE using computerized tomography pulmonary angiography or cardiac echography. Relevant clinical, laboratory and radiological features were collected.ResultsSixty-seven patients out of 205 (32.7%) (median age 68 [57–81], 17/67 [25%] females) had a COVID-19 pneumonia complicated with APE. The median duration from the onset of first COVID-19 symptoms to the diagnosis of APE was 8 [3.5–11.5] days. Medical past history, comorbidities and thromboembolic risk factors of were not different among patients with or without APE. Thirty percent of patients with APE had no thromboembolic risk factor. Higher levels of eosinophils, CRP and D-dimers and lower pH levels constituted the best model to predict this complication with an area under curve [AUC] of 0.90. Association of D-dimers > 3000 ng/L and CRP > 90 mg/L had a predictive positive value of 0.84 and this predictive model had an AUC of 0.88 (0.83–0.93).ConclusionAPE is a frequent complication of COVID-19 pneumonia. Patient history is not associated with the risk of APE. The combination of D-dimers and CRPs greater than 3000 mg/L and 90 mg/L respectively has a PPV of 84%.

55 Positivity Rates of CT Imaging for Pulmonary Embolism in COVID-19 Patients

Early evidence has suggested a high prevalence of acute pulmonary embolism (PE) in Coronavirus 19 (COVID). However, the bulk of existing data evaluates the population of COVID patients admitted to an intensive care unit (ICU). There has been limited evidence in the emergency department (ED) population and as a result, there is variability in diagnostic evaluation for patients presenting with COVID. The objective of this study was to describe the diagnostic evaluation of both COVID positive and negative patients in the ED.

COVID-19 pneumonia: microvascular disease revealed on pulmonary dual-energy computed tomography angiography.

Increased prevalence of acute pulmonary embolism in COVID-19 has been reported in few recent studies. Some works have highlighted pathological changes on lung microvasculature with local pulmonary intravascular coagulopathy that may explain pulmonary artery thrombosis found on pulmonary computed tomography (CT) angiography. The objective of our study was to describe lung perfusion disorders assessed by pulmonary dual-energy CT (DECT) angiography in severe COVID-19 patients. This single center retrospective study included 85 consecutive patients with a reverse transcriptase-polymerase chain reaction diagnosis of SARS-CoV-2 who underwent a pulmonary DECT angiography between March 16th 2020 and April 22th 2020. Pulmonary DECT angiography was performed when the patient had severe clinical symptoms or suffered from active neoplasia or immunosuppression. Two chest radiologists performed pulmonary angiography analysis in search of pulmonary artery thrombosis and a blinded semi quantitative analysis of iodine color maps focusing on the presence of parenchymal ischemia. The lung parenchyma was divided into volumes based on HU values. DECT analysis included lung segmentation, total lungs volume and distribution of lung perfusion assessment. Twenty-nine patients (34%) were diagnosed with pulmonary artery thrombosis, mainly segmental (83%). Semi-quantitative analysis revealed parenchymal ischemia in 68% patients of the overall population, with no significant difference regarding absence or presence of pulmonary artery thrombosis (23 vs. 35, P=0.144). Inter-reader agreement of parenchymal ischemia between reader 1 and 2 was substantial [0.74; interquartile range (IQR): 0.59-0.89]. Volume of ischemia was significantly higher in patients with pulmonary artery thrombosis [29 (IQR, 8-100) vs. 8 (IQR, 0-45) cm3, P=0.041]. Lung parenchyma was divided between normal parenchyma (59%, of which 34% was hypoperfused), ground glass opacities (10%, of which 20% was hypoperfused) and consolidation (31%, of which 10% was hypoperfused). Pulmonary perfusion evaluated by iodine concentration maps shows extreme heterogeneity in COVID-19 patients and lower iodine levels in normal parenchyma. Pulmonary ischemic areas were more frequent and larger in patients with pulmonary artery thrombosis. Pulmonary DECT angiography revealed a significant number of pulmonary ischemic areas even in the absence of visible pulmonary arterial thrombosis. This may reflect microthrombosis associated with COVID-19 pneumonia.

Acute pulmonary embolism in non-hospitalized COVID-19 patients referred to CTPA by emergency department.

ObjectivesTo evaluate the prevalence of acute pulmonary embolism (APE) in non-hospitalized COVID-19 patients referred to CT pulmonary angiography (CTPA) by the emergency department.MethodsFrom March 14 to April 6, 2020, 72 non-hospitalized patients referred by the emergency department to CTPA for COVID-19 pneumonia were retrospectively identified. Relevant clinical and laboratory data and CT scan findings were collected for each patient. CTPA scans were reviewed by two radiologists to determinate the presence or absence of APE. Clinical classification, lung involvement of COVID-19 pneumonia, and CT total severity score were compared between APE group and non-APE group.ResultsAPE was identified in 13 (18%) CTPA scans. The mean age and D-dimer of patients from the APE group were higher in comparison with those from the non-APE group (74.4 vs. 59.6 years, p = 0.008, and 7.29 vs. 3.29 μg/ml, p = 0.011). There was no significant difference between APE and non-APE groups concerning clinical type, COVID-19 pneumonia lung lesions (ground-glass opacity: 85% vs. 97%; consolidation: 69% vs. 68%; crazy paving: 38% vs. 37%; linear reticulation: 69% vs. 78%), CT severity score (6.3 vs. 7.1, p = 0.365), quality of CTPA (1.8 vs. 2.0, p = 0.518), and pleural effusion (38% vs. 19%, p = 0.146).ConclusionsNon-hospitalized patients with COVID-19 pneumonia referred to CT scan by the emergency departments are at risk of APE. The presence of APE was not limited to severe or critical clinical type of COVID-19 pneumonia.Key Points • Acute pulmonary embolism was found in 18% of non-hospitalized COVID-19 patients referred by the emergency department to CTPA. Two (15%) patients had main, four (30%) lobar, and seven (55%) segmental acute pulmonary embolism. • Five of 13 (38%) patients with acute pulmonary embolism had a moderate clinical type. • Severity and radiological features of COVID-19 pneumonia showed no significant difference between patients with or without acute pulmonary embolism.

The incidence of acute pulmonary embolism following syncope in anticoagulant-naïve patients: A retrospective cohort study.

BackgroundA recently published, large prospective study showed unexpectedly high prevalence of acute pulmonary embolism (APE) among patients hospitalized for syncope. In such a case, a high incidence of recurrent pulmonary embolism is expected among patients who were discharged without APE workup.ObjectivesTo determine the incidence of symptomatic APE among patients hospitalized for a first episode of syncope and discharged without APE workup or anticoagulation.MethodsThis retrospective cohort study included patients hospitalized at Rambam Health Care Campus between January 2006 and February 2017 with a primary admission diagnosis of syncope, who were not investigated for APE and were not taking anticoagulants. The patients were followed up for up to three years after discharge. The occurrence of venous thromboembolism (VTE) during the follow-up period was documented.ResultsThe median follow-up duration was 33 months. 1,126 subjects completed a three-year follow-up. During this period, 38 patients (3.38%) developed VTE, 17 (1.51%) of them had APE. The cumulative incidence of VTE and APE was 1.9% (95% CI 1.3%-2.5%) and 0.9% (95% CI 0.4%-1.3%) respectively. Only seven subjects developed APE during the first year of follow-up. The median times from the event of syncope to the development of APE and VTE were 18 and 19 months respectively.ConclusionsThe cumulative incidence of VTE during a three-year follow-up period after an episode of syncope is low. In the absence of clinical suspicion, a routine diagnostic workup for APE in patients with syncope cannot be recommended.

Improving appropriate use of pulmonary computed tomography angiography by increasing the serum D-dimer threshold and assessing clinical probability.

To determine whether the implementation of an increased D-dimer threshold value and clinical probability assessment increases the prevalence of pulmonary embolism (PE) in patients undergoing pulmonary computed tomography angiography (PCTA) in an Emergency Department setting. A retrospective review of all patients undergoing PCTA during 2 separate 12-month intervals, 1 before the implementation of an increased D-dimer threshold and recommendation for formal clinical probability assessment and the other after regional implementation. The primary outcome measure was the prevalence of acute PE in each of the samples. After the implementation of the increased D-dimer threshold and recommendation for formal clinical probability assessment, the prevalence of PE detected by PCTA increased from 4.7% to 11.7% (p < 0.001). Among all PCTAs performed after the new guidelines were promulgated, 8.6% were still performed on patients who had serum D-dimer values lower than the threshold of 1.0 µg/mL. Despite the recommendation for formal clinical probability assessment before ordering a PCTA, only 4% of patients had a formal clinical probability assessment recorded in their electronic medical record. The implementation of an increased D-dimer threshold value increased the prevalence of PE in patients undergoing PCTA in an Emergency Department setting, but more consistent application of clinical probability assessment remains an elusive target.

Acute Pulmonary Embolism in Young: A Prospective Observational Study on Clinical Implication of Age on the Presentation and Management of Patients with Acute Pulmonary Embolism

Acute Pulmonary Embolism in Young: A Prospective Observational Study on Clinical Implication of Age on the Presentation and Management of Patients with Acute Pulmonary Embolism Prevalence of acute pulmonary embolism is increasing in general population especially in old population. Prevalence of acute pulmonary embolism in young adults is unknown.

Transfemoral Catheter Thrombolysis and Use of Sildenafil in Acute Massive Pulmonary Embolism

ACUTE PULMONARY EMBOLISM (PE) develops in approximately 630,000 people annually and contributes to 200,000 deaths annually. 1 Dalen J.E. Alpert J.S. Natural history of pulmonary embolism. Prog Cardiovasc Dis. 1975; 17: 259-270 Abstract Full Text PDF PubMed Scopus (955) Google Scholar The prophylactic use of heparin, vitamin K antagonists, or compression stockings are standard care in hospitalized individuals and particularly important in surgical patients because they have an increased risk for deep venous thrombosis and pulmonary embolism. The mortality associated with massive PE is secondary to acute right-heart failure and circulatory shock. 2 Lualdi J.C. Goldhaber S.Z. Right ventricular dysfunction after acute pulmonary embolism: Pathophysiologic factors, detection, and therapeutic implications. Am Heart J. 1995; 130: 1276-1282 Abstract Full Text PDF PubMed Scopus (263) Google Scholar Estimated mortality in the post-thrombolytic era in patients with acute PE with hemodynamic instability is between 23% and 38% 3 Arcasoy S.M. Kreit J.W. Thrombolytic therapy of pulmonary embolism: A comprehensive review of current evidence. Chest. 1999; 115: 1695-1707 Crossref PubMed Scopus (218) Google Scholar , 4 Dalen J.E. Alpert J.S. Hirsh J. Thrombolytic therapy for pulmonary embolism: Is it effective? Is it safe? When is it indicated?. Arch Intern Med. 1997; 157: 2550-2556 Crossref PubMed Google Scholar ; approximately 90% of these deaths occur within 2 hours of the onset of symptoms. 5 Soloff L.A. Rodman T. Acute pulmonary embolism II. Clinical. Am Heart J. 1967; 74: 829-847 Abstract Full Text PDF PubMed Scopus (70) Google Scholar , 6 Soloff L.A. Rodman T. Acute pulmonary embolism I. Review. Am Heart J. 1967; 74: 710-724 Abstract Full Text PDF PubMed Scopus (32) Google Scholar , 7 Stein P.D. Henry J.W. Prevalence of acute pulmonary embolism among patients in a general hospital and at autopsy. Chest. 1995; 108: 978-981 Crossref PubMed Scopus (609) Google Scholar , 8 Tapson V.F. Witty L.A. Massive pulmonary embolism Diagnostic and therapeutic strategies. Clin Chest Med. 1995; 16: 329-340 PubMed Google Scholar Acute right-heart failure together with poor filling of the left heart are indicative; this condition may rapidly lead to circulatory arrest. 2 Lualdi J.C. Goldhaber S.Z. Right ventricular dysfunction after acute pulmonary embolism: Pathophysiologic factors, detection, and therapeutic implications. Am Heart J. 1995; 130: 1276-1282 Abstract Full Text PDF PubMed Scopus (263) Google Scholar

Prevalence of Acute Pulmonary Embolism in Central and Subsegmental Pulmonary Arteries and Relation to Probability Interpretation of Ventilation/Perfusion Lung Scans

The purpose of this investigation is to determine the prevalence of acute pulmonary embolism (PE) limited to subsegmental pulmonary arteries. Contrast-enhanced helical (spiral) and electron-beam CT, in the hands of experienced radiologists who are skillful with this modality, are sensitive for the detection of acute PE in central pulmonary arteries, but have a low sensitivity for the detection of PE limited to subsegmental pulmonary arteries. The potential for CT to diagnose PE, therefore, is partially dependent on the prevalence of PE limited to subsegmental pulmonary arteries. Data are from the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). The largest pulmonary arteries that showed PE, as interpreted by the PIOPED angiographic readers, were identified in 375 patients in PIOPED with angiographically diagnosed PE. Among all patients with PE, 6% (95% confidence interval [CI], 4 to 9%) had PE limited to subsegmental branches of the pulmonary artery. Patients with high-probability ventilation/ perfusion (V/Q) scans had PE limited to subsegmental branches in only 1% (95% CI, 0 to 4%). Among patients with low-probability V/Q lung scans, 17% (95% CI, 8 to 29%) had PE limited to the subsegmental branches. Patients with low-probability V/Q scans and no prior cardiopulmonary disease had PE limited to the subsegmental pulmonary arteries in 30% (95% CI, 13 to 53%), whereas patients with low-probability V/Q scans who had prior cardiopulmonary disease had PE limited to subsegmental pulmonary arteries in 8% (95% CI, 2 to 22%) (p < 0.05). Based on data from all patients with PE in PIOPED, the prevalence of PE limited to subsegmental pulmonary arteries is low, 6%. PE limited to subsegmental pulmonary arteries was most prevalent among patients with low-probability V/Q scans, particularly if they had no prior cardiopulmonary disease.

Diagnosis and management of pulmonary embolism.

The prevalence of acute pulmonary embolism in a general hospital was evaluated. Importantly, the prevalence of unrecognized pulmonary embolism at autopsy has not changed in three decades. Further evaluation was made of the alveolar-arterial oxygen difference in the diagnosis of acute pulmonary embolism. As with the partial pressure of oxygen in arterial blood, the alveolar arterial oxygen difference is usually abnormal, but a normal value does not exclude pulmonary embolism. The criteria used for a low probability interpretation of ventilation-perfusion lung scans in the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) were modified. Criteria for a very low probability assessment (< 10% positive predictive value) were also determined. Progress was made with helical computed tomography and contrast-enhanced electron-beam computed tomography, but with present technology their role is limited. Selective digital subtraction angiography with a flow directed catheter seems to have been useful in some patients. A strategy for diagnosis of thromboembolic disease that uses serial noninvasive leg tests was described. The strategy reduces the number of pulmonary angiograms required. The Fourth American College of Chest Physicians Conference on Antithrombotic Therapy was published. Extensive and detailed analysis was made of the literature related to the antithrombotic treatment of pulmonary embolism and the use of antithrombotic therapy during pregnancy.

Prevalence of Acute Pulmonary Embolism Among Patients in a General Hospital and at Autopsy

The purpose of this investigation is to estimate the prevalence of acute pulmonary embolism (PE) in a general hospital, its frequency among patients who died, and the ability of physicians to diagnose PE antemortem. The prevalence of acute PE among 51,645 patients hospitalized over a 21-month period was assessed in 1 of the 6 clinical centers (Henry Ford Hospital) that participated in the collaborative study, prospective investigation of pulmonary embolism diagnosis (PIOPED). The diagnosis of PE was made by pulmonary angiography, or in those who did not undergo pulmonary angiography because they declined or were ineligible for randomization to angiography in PIOPED, the diagnosis was based on the ventilation/perfusion (V/Q) lung scan. Based on data in PIOPED, PE was considered to be present in 87% of patients with high probability V/Q scam interpretations, 30% with intermediate probability interpretations, 14% with low probability interpretations, and 4% with nearly normal V/Q scans. The estimated prevalence of acute PE in hospitalized patients was 526 of 51,645 (1.0%; 95% confidence interval [CI], 0.9 to 1.1%). Based on extrapolated data from autopsy, PE was estimated to have caused or contributed to death in 122 of 51,645 (0.2%; 95% CI, 0.19 to 0.29%). Pulmonary embolism was observed at autopsy in 59 of 404 (14.6%; 95% CI, 11.3 to 18.4%). Among patients with PE at autopsy, the PE caused or contributed to death in 22 of 59 (37.3%; 95% CI, 25.0 to 50.9%) and PE was incidental in 37 of 59 (62.7%; 95% CI, 49.1 to 75.0%). Among patients at autopsy who died from PE, the diagnosis was unsuspected in 14 of 20 (70.0%; 95% CI, 45.7 to 88.1%). Most of these patients had advanced associated disease. In these patients, death from PE occurred within 2.5 h in 13 of 14 (92.9%; 95% CI, 66.1 to 99.8%). Pulmonary embolism is common in a general hospital. The prevalence of PE at autopsy has not changed over 3 decades. The frequency of unsuspected PE in patients at autopsy has not diminished. Even among patients who die from PE, the PE is usually unsuspected. Such patients, however, typically have advanced disease. Among moribund patients, incidental PE is rarely diagnosed. Patients who suffer sudden unexplained catastrophic events in the hospital are a group in whom the diagnosis might be suspected more frequently if physicians maintain a high index of suspicion.

Diagnóstico gammagráfico del tromboembolismo pulmonar agudo

We aimed to determine the prevalence of acute pulmonary embolism (APE) in our population and to establish the diagnostic reliability of pulmonary scintigraphy (PS), as well as the influence of the clinical context (CC). During a 2-year prospective study, patients were diagnosed by either pulmonary angiography or normal-perfusion PS. A diagnosis of APE was made in 73 (75%) of a total of 97 patients. In the group of 58 patients diagnosed by ventilation/perfusion (V/Q) PS, 33 were classified as "highly probably" having APE; 32 of these in fact had the syndrome (sensitivity 88%, specificity 94%). Combining the "highly probable" patients with the "highly suspected" patients diagnosed by ventilation/perfusion PS, we obtained a sensitivity of 51% and specificity of 100%. Ventilation scintigrams were unobtainable in 28 older patients with greater dyspnea and tachypnea, who were unable to perform the maneuvers. Of the 21 "highly probable" patients as assessed by PS, 19 were diagnosed as having APE (sensitivity 86%, specificity 85%). Combining the "highly probable" patients with the "highly suspected" group, we obtained a sensitivity of 32% and specificity of 100%. Normal perfusion PS excludes clinically relevant APE. "Intermediate" or "slight" probability PS results, even when combined with CC, have no diagnostic validity.