Pulmonary Embolism Group Research Articles

Diagnostic Value of the Alveolar-Arterial Oxygen Gradient in Pulmonary Embolism: A Cross-Sectional Study.

Background/Objectives: Pulmonary embolism (PE) is a potentially serious condition characterized by the blockage of blood vessels in the lungs, often presenting significant diagnostic challenges due to its non-specific symptoms. This study aimed to evaluate the utility of the alveolar-arterial (A-a) oxygen gradient as a diagnostic tool for PE, hypothesizing that it could enhance early detection when combined with other clinical markers. Methods: We retrospectively analyzed 168 patients at the University Hospital Center Split. This study correlated A-a gradients with PE confirmed by CT pulmonary angiography. Key clinical and biochemical markers, including heart rate, C-reactive protein (CRP), pro-brain natriuretic peptide (NT-proBNP), D-dimer, high-sensitivity troponin (hs-troponin), and arterial oxygen pressure (PaO2), were assessed. Results: Our findings revealed that patients with PE had significantly higher A-a gradients than those without PE. The observed-to-expected ratio for the A-a gradient was notably increased in the PE group. Additionally, patients with PE exhibited elevated heart rate, CRP, NT-proBNP, D-dimer, and hs-troponin levels, while PaO2 levels were notably lower. Conclusions: This study demonstrates that an elevated A-a gradient reflects the severity of gas exchange impairment in PE. The results suggest that early diagnosis of PE may be improved by incorporating A-a gradient analysis alongside other clinical markers, potentially leading to more effective and timely interventions.

Pulmonary embolism in children with mycoplasma pneumonia: can it be predicted?

To investigate the clinical characteristics of Mycoplasma pneumoniae (MP) pneumonia (MPP) combined with pulmonary embolism (PE) in children. 291 hospitalized pediatric cases with MPP were enrolled from January 2018 to May 2024 and divided into the PE group (141 cases) and non-PE control group (150 cases). Clinical data of both groups were analyzed and compared. C-reactive protein (CRP), D-dimer, lactate dehydrogenase (LDH), and interleukin 6 (IL-6) were significantly higher in the PE group than in the non-PE control group. There were 85 males and 56 females in the PE group. The PE group has male-to-female ratio of 3: 2,and hemoptysis was observed in 11 children (7.08%), chest pain in 29 children (20.60%), and pulmonary necrosis in 89 children (63.12%). In the receiver operator curve(ROC), the areas under the curve(AUC) for D-dimer, CRP, IL-6, and LDH were 0.964, 0.690, 0.632, and 0.765, respectively. In the ROC curve, the cutoff values for D-dimer, CRP, IL-6, and LDH were 0.8µg/ml, 24.2mg/L, 37.8 pg/ml, and 461 U/L, respectively. A proportion of children with MP infection combined with PE show atypical clinical symptoms. Children with MPP and elevated D-dimer levels, IL-6, CRP, erythrocyte sedimentation rate (ESR), and LDH may be prone to develop PE.

Clinical manifestations and misdiagnosis factors of pulmonary embolism patients seeking treatment in cardiology.

To explore the clinical manifestations and factors leading to misdiagnosis in pulmonary embolism (PE) patients in a cardiology department. We retrospectively analyzed 74 patients diagnosed with PE at our hospital from March 2018 to March 2022, comparing them to 136 patients suspected of PE but excluded by computed tomography pulmonary angiography during the same period. Both groups received the same basic care, including disease counseling, nutritional planning, and monitoring. We compared general information, clinical manifestations, risk factors, and auxiliary examinations to identify correlations between specific manifestations and misdiagnosis factors. The male-to-female ratio in the PE group was approximately 3:4, which was statistically significant compared to the control group (P < .05), though its impact on PE incidence was low. Common symptoms in the PE group included chest tightness, shortness of breath, sweating, and chest pain, with no significant difference from the control group (P > .05). Notable risk factors included deep vein thrombosis (DVT) (43.24%), prolonged bed rest (32.43%), lower limb varicose veins (18.92%), trauma (21.62%), pulmonary infections (62.16%), coronary heart disease (37.84%), respiratory failure (32.43%), and chronic obstructive pulmonary disease (13.51%). DVT was significantly associated with PE (P < .05). Multivariate logistic regression identified DVT (OR = 118.528, 95% CI: 6.959-2018.906, P = .001) and lower limb varicose veins (OR = 212.766, 95% CI: 6.584-6875.950, P = .003) as independent predictive factors for suspected PE. Clinical manifestations strongly correlated with PE included pulmonary rales, cyanosis, tachycardia, hypotension, elevated D-dimer, positive N-terminal pro-brain natriuretic peptide, and sinus tachycardia on echocardiogram. PE in cardiology patients may present with pulmonary rales, hypotension, shortness of breath, and abdominal symptoms, warranting reexamination for PE. Misdiagnosis factors typically involve chest pain, tightness, and shortness of breath. Lower limb varicose veins and DVT are reliable predictors of suspected PE.

Identification of oxylipins and lipid mediators in pulmonary embolism

BackgroundThis study aimed to investigate the role of oxylipins and lipid mediators in Pulmonary Embolism (PE), a serious cardiovascular condition associated with high morbidity and mortality rates.MethodsA total of 6,365 hospitalized patients with thrombosis and 200 healthy individuals were recruited as the control group from 2015 to 2023. Thrombus type, coagulation, and lipid-related parameters were statistically analysed. Additionally, lipidomic characteristics of serum samples from the PE and control groups were examined via LC-MS/MS for the first time.ResultsAmong the 6,365 hospitalized patients with thrombosis, 72.1% (4,587/6,365) had venous thromboembolism (VTE). Within the VTE group, the incidence of PE was 12.1% (555/4,587). In comparison to the healthy control (HC) group, the PE group exhibited significant elevations in coagulation-related parameters, such as factor VIII (F VIII) and von Willebrand factor (vWF) activities, while antithrombin III (AT III) and factor XII (F XII) activities were notably reduced. Lipid-related parameters, including serum cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A (apoA), were significant reductions in PE patients (P < 0.0001), with areas under the curve (AUCs) exceeding 0.9. LC-MS/MS analysis of serum samples revealed 118 oxidized lipid metabolites. Compared to the HC group, the PE group exhibited 10 upregulated oxidized lipid metabolites, with the most significant difference observed in 20-hydroxyPGF2α derived from arachidonic acid (ARA). The study identified upregulated oxidized lipid metabolites primarily linked to the ARA metabolism signalling pathway.ConclusionThis research indicates a notable correlation between lipid metabolism and the occurrence and development of PE. Specifically, upregulation of the arachidonic acid metabolism signalling pathway may be an important pathogenic factor for PE, and 20-hydroxyPGF2α derived from ARA has potential as a biomarker for PE disease.

The influence of the NRG1/ERBB4 signaling pathway on pulmonary artery endothelial cells.

This study aimed to examine the influence of the Neuregulin-1 (NRG1)/ERBB4 signaling pathway on the function of human pulmonary artery endothelial cells (HPAECs) and investigate the underlying mechanisms. Enzyme-linked immunosorbent assay indicated that ERBB4 levels in the serum of patients with pulmonary embolism (PE) were significantly higher than those of healthy controls (p < 0.05). In cellular studies, thrombin stimulation for 6 h led to a significant decrease in cell viability and overexpression of ERBB4 compared to control (p < 0.05). In the NRG1 group, apoptosis of HPAECs was reduced (p < 0.05), accompanied by a decrease in ERBB4 expression and an increase in p-ERBB4, phosphorylated serine/threonine kinase proteins (Akt) (p-Akt), and p-phosphoinositide 3-kinase (PI3K) expression (p < 0.05). In the AG1478 group, there was a significant increase in HPAEC apoptosis and a significant decrease in p-ERBB4 and ERBB4 expression compared to the Con group (p < 0.05). In the AG1478 + NRG1 group, there was an increase in the apoptosis rate and a significant decrease in the expression of p-ERBB4, ERBB4, p-Akt, and phosphorylated PI3K compared to the NRG1 group (p < 0.05). In animal studies, the PE group showed an increase in the expression of ERBB4 and p-ERBB4 compared to the Con group (p < 0.05). NRG1 treatment led to a significant reduction in embolism severity with decreased ERBB4 expression and increased p-ERBB4 expression (p < 0.05). Gene set enrichment analysis identified five pathways that were significantly associated with high ERBB4 expression, including CHOLESTEROL HOMEOSTASIS, OXIDATIVE PHOSPHORYLATION, and FATTY ACID METABOLISM (p < 0.05). Therefore, NRG1 inhibits apoptosis of HPAECs, accompanied by a decrease in ERBB4 and an increase in p-ERBB4. NRG1 inhibition in HPAECs apoptosis can be partially reversed by inhibiting ERBB4 expression with AG1478. ERBB4 has the potential to be a novel biological marker of PE.

Venous thromboembolism during three muslim pilgrimage seasons

Background Acute pulmonary embolism (PE) is a potentially fatal condition for which prompt recognition, risk assessment and appropriate treatment must be implemented to reduce mortality and morbidity. This study was planned to analyze all cases of venous thromboembolism (VTE) admitted to the tertiary care hospital during three successive Muslim hajj seasons. Methods A prospective observational study that included 135 patients of which 65 patients were with deep vein thrombosis (DVT group), 50 patients were with pulmonary embolism (PE group) and 20 patients were with concomitant DVT and PE (DVT/PE group). All patients were subjected to full history taking, clinical examination, laboratory, and radiological studies. Results The presentation with hemodynamic compromise and the percentage of mortality were more in patients with DVT/ PE compared to patients with PE alone. The patients in the DVT group had the highest D-dimer and triglyceride levels. The patients in the PE group had the most severe tachypnea and the highest values of cardiac biomarkers and aminotransferases. The patients in the DVT/PE group had the most rapid average pulse, the lowest average blood pressure, and the lowest oxygen saturation. Conclusions The presentations with DVT or DVT/PE were more in females and presentation with PE without DVT was more in males. Hajjis with VTE presented with less frequent symptoms, more overt clinical signs, more hemodynamic compromise and overall mortality compared to other studies. The study information may encourage the designated health authorities to raise awareness and implement VTE preventive measures during pilgrimage season.

Thrombosis density ratio can predict the occurrence of pulmonary embolism and post-thrombotic syndrome in lower-extremity deep vein thrombosis patients.

Deep vein thrombosis (DVT) formation of lower extremities can lead to serious complications including pulmonary embolism (PE) and chronic post-thrombotic syndrome (PTS). We aimed to explore the relationship between the ratio of thrombotic density and the occurrence of PE and PTS in patients with DVT of the lower extremities. A retrospective analysis was conducted in patients who performed computed tomography venography, dividing into DVT with PE group (54 patients) and DVT-alone group (34 patients), The clinical data were recorded. Univariate and multivariate logistic regression analysis were used to analysis variables associated with PE. The ability of thrombosis density ratio and Wells score to diagnose PE was evaluated by using the receiver operating characteristic curve (ROC) area under the curve (AUC). According to the treatment and follow-up results, subgroup analysis was performed, and the Villata score was used to determine the presence or absence of PTS and its severity. Compare with the DVT-alone group, more patients had dyspnea and chest pain in the DVT with PE group. DVT with PE group had lower the percentage of neutrophils, white blood cell count and platelet count, while had higher blood cell count, D-dimer, wells score, thrombus and thrombus density ratio. Multivariate logistic analysis showed that percentage of neutrophils (OR(95% CIs)=1.15 (1.01,1.31), P = 0.040), platelets (OR(95% CIs)=0.96 (0.93,0.99), P = 0.011), and thrombus density ratio (OR(95% CIs)=5.99 (1.96,18.35), P = 0.002) are independent predictors of PE. The Wells score and thrombosis density ratio were consistent in the diagnostic efficacy of PE. In the subgroup analysis, there was a relevance between the ratio of thrombosis density and the Villalta score. Percentage of neutrophils, platelets, and thrombus density ratio are independent predictors of PE. The thrombosis density of DVT patients may be an index to predict the risk of PE and PTS in DVT patients.

Treatment of high- and intermediate-high-risk pulmonary embolism by the Pulmonary Embolism Response Team: Focus on catheter-directed therapies.

Multidisciplinary Pulmonary Embolism Response Teams (PERTs) were established to individualize the treatment of high-risk (HR) and intermediate-high-risk (IHR) pulmonary embolism (PE) patients, which pose a challenge in clinical practice. We retrospectively collected the data of all HR and IHR acute PE patients consulted by PERT CELZAT between September 2017 and October 2022. The patient population was divided into four different treatment methods: anticoagulation alone (AC), systemic thrombolysis (ST), surgical embolectomy (SE), and catheter-directed therapies (CDTx). Baseline clinical characteristics, risk stratification, PE severity parameters, and treatment outcomes were compared between the four groups. Of the 110 patients with HR and IHR PE, 67 (61%) patients were treated with AC only, 11 (10%) with ST, 15 (14%) underwent SE, and 17 (15%) were treated with CTDx. The most common treatment option in the HR group was reperfusion therapy, used in 20/24 (83%) cases, including ST in 7 (29%) patients, SE in 5 (21%) patients, and CTDx in 8 (33%) patients. In contrast, IHR patients were treated with AC alone in 63/86 (73%) cases. The in-hospital mortality rate was 9/24 (37.5%) in the HR group and 4/86 (4.7%) in the IHR group. The number of advanced procedures aimed at reperfusion was substantially higher in the HR group than in the IHR PE group. Despite the common use of advanced reperfusion techniques in the HR group, patient mortality remained high. There is a need further to optimize the treatment of patients with HR PE to improve outcomes.

Evaluation of patients who underwent computed tomography angiography with the pre-diagnosis of pulmonary embolism

Aim: Pulmonary embolism (PE) is a disease that develops as a result of occlusion of the pulmonary artery or its divisions by thrombus deriving from the systemic deep venous system. PE ranks third among deaths caused by cardiovascular disease. PE is a preventable illness with elevated mortality and morbidity, repetitive and hard to diagnose. In this study, computed tomography angiography (CTA) images and blood parameters of patients who underwent CTA with a prediagnosis of PE in Adiyaman Training and Research Hospital between 01/03/2020-01/09/2022 were examined. Materials and Methods: Patients who underwent CTA with suspected PE were analyzed, and a comparison was made between the sociodemographic and laboratory data of those diagnosed with PE and those who were not. Results: The mean age of PE patients was importantly higher than non-PE patients, and there was no statistical variance in the gender distribution of the groups. Monocyte count was markedly higher in the PE group, and the CAR value remarkably higher in the non-PE group than in the PE group. According to the ROC analysis, the AUC value was the highest when the D-dimer and troponin I value were considered together. Two different cut-offs were found for D-dimer. When D-dimer was 655 mg/dL, the specificity was 96.5%, while when D-dimer was 438.5 mg/dL, the sensitivity was 92.2%. The highest specificity was found with troponin I (97.4%). The likelihood ratio (LR) was the highest, at 26.08, when D-dimer was 655 mg/dL and above. Conclusion: As a result, the main message of our study is that when making differential diagnosis in patients who apply to the emergency department with dyspnea and chest pain, better diagnostic accuracy can be achieved with the combined evaluation of tomographic findings and laboratory findings. Therefore, evaluation of laboratory values such as D-dimer, hemogram parameters and troponin I is important in diagnosis and risk classification.

Evaluation of Hemogram Parameters in the Diagnosis of Pulmonary Embolism: Immature Granulocytes and Other New Tips.

Pulmonary embolism (PE) is an important cause of sudden death and is difficult to diagnose. Therefore unnecessary radiological investigations are often resorted to. Although some inflammatory parameters in the hemogram have been found to play a role in the diagnosis of PE, many parameters have not been adequately investigated. We aimed to evaluate potential inflammatory parameters in hemogram in the diagnosis of PE and to determine the parameters with the highest diagnostic value. This single-center, retrospective study was performed by evaluating 114 cases with suspected PE admitted to the emergency department between January 2017 and June 2022. Among 114 cases, 62 cases with a definitive diagnosis of PE by pulmonary computed tomography angiography served as the PE group and 52 cases without PE served as the control group. Admission hemogram parameters of both groups were recorded. Potential chronic diseases and acute conditions affecting hemogram were excluded from the study. In the multivariate model; immature granulocyte (IG), neutrophil/lymphocyte ratio (NLR), monocyte % and platelet large cell ratio (P-LCR) were found to be significantly and independently effective in differentiating cases with and without PE (P˂.05). Our findings suggest that high IG, high NLR, high monocyte %, and low P-LCR values have diagnostic value in cases with suspected PE. However the usability of IGs in the diagnosis of PE is a new finding. Hemogram is cheap, easily accessible, and potential inflammatory biomarkers in hemograms may increase physicians' awareness in the diagnosis of PE.

Indicators for Hospitalization in Acute Pulmonary Embolism: Uncover the Association Between D-dimer Levels, Thrombus Volume and Radiomics

The advent of advanced computed tomography (CT) technology and the field of radiomics has opened up new avenues in diagnostic assessments. Increasingly, there is substantial evidence advocating for the incorporation of quantitative imaging biomarkers in the clinical decision-making process.This study aimed to examine the correlation between D-dimer levels and thrombus size in acute pulmonary embolism (PE) combining dual-energy CT (DECT) and radiomics and to investigate the diagnostic utility of a machine learning classifier based on dual-energy computed tomography (DECT) radiomics for identifying patients with a complicated course, defined as at least hospitalization at IMC. The study was conducted including 136 participants who underwent pulmonary artery CT angiography from January 2015 to March 2022. Based on DECT imaging, 107 radiomic features were extracted for each patient using standardized image processing. After dividing the dataset into training and test sets, stepwise feature reduction based on reproducibility, variable importance and correlation analyses were performed to select the most relevant features; these were used to train and validate the gradient-boosted tree models.Receiver operating characteristics (ROC) analysis was utilized to evaluate the association between volumetric, laboratory data and adverse outcomes. In the central PE group, we observed a significant correlation between thrombus volumetrics and D-dimer levels (p=0.0037), as well as between thrombus volumetrics and hospitalization at the Intermediate Care Unit (IMC) (p=0.0001). In contrast, no statistically significant differences were identified in thrombus sizes between patients who experienced complications and those who had a favorable course (p=0.3162). The trained machine learning classifier achieved an accuracy of 61% and 55% in identifying patients with a complicated course, as indicated by an area under the ROC curve of 0.63 and 0.58. In conclusion, our findings indicate a positive correlation between D-dimer levels and central PE's pulmonary embolic burden. Thrombus volumetrics may serve as an indicator for complications and outcomes in acute PE patients. Thus, thrombus volumetrics, as opposed to D-dimers, could be an additional marker for evaluating embolic disease severity. Moreover, DECT-derived radiomic feature models show promise in identifying patients with a complicated course, such as hospitalization at IMC.

Effectiveness and Safety of Large-Bore Aspiration Thrombectomy for Intermediate- or High-Risk Pulmonary Embolism

PurposeTo evaluate effectiveness and safety of large-bore mechanical thrombectomy of intermediate- or high-risk pulmonary embolism (PE) and factors associated with effectiveness. Materials and MethodsA retrospective review of 257 patients with intermediate- or high-risk PE who underwent mechanical thrombectomy using the Flowtriever system (Inari Medical, Irvine, California) between July 2019 and November 2021 was conducted. Data were analyzed using the linear regression and Kaplan-Meier methods with a Type 1 error set at 0.05. ResultsPatients’ mean age was 62 years, and 51% were male. PE risk was classified as high, intermediate-high, and intermediate-low in 37 (14%), 201 (78%), and 18 (7%) of the patients, respectively. Procedural technical success was 100%. The mean pulmonary artery pressure (MPAP) decreased from a mean of 32 mmHg (SD ± 9) before to 24 mmHg (SD ± 9) after thrombectomy (mean decrease, 8 mmHg [SD ± 6]; P < .0001). Immediate complications occurred in 2% of the patients. Postprocedural 30-day and all-time PE-attributable mortality in a mean of 1.3-year follow-up was 2% and 6%, respectively. In multivariate analysis, the presence of lower extremity DVT at presentation (β ± SE, −7.60 ± 3.22; P = .019) and a higher prethrombectomy MPAP (β ± SE, −0.19 ± 0.04; P < .001) were associated with lower degrees of decrease in MPAP in the intermediate-high–risk PE group. Among 14 patients with postthrombectomy PE-attributable mortality, 13 had postthrombectomy MPAPs of >20 mmHg. ConclusionsLarge-bore aspiration thrombectomy is a safe and effective treatment for reducing PAP in patients with intermediate- or high-risk PE. Postthrombectomy MPAPs of >20 mmHg might indicate postthrombectomy PE-attributable mortality in high-risk patients.

Impact of Cardiac and Cerebrovascular Complications During Hospitalization on Long-Term Prognosis in Patients With COVID-19

The impact of cardiac and cerebrovascular events during COVID-19 hospitalization on long-term prognosis remains uncertain. We aimed to evaluate the effect of myocardial infarction (MI), cerebrovascular accident (CVA), and pulmonary embolism (PE) during hospitalization on the long-term prognosis in patients who survived COVID-19 hospitalization. A retrospective observational analysis was performed on a cohort of 2,389 patients who survived COVID-19 hospitalization in our institution between January and June 2020. The patients were divided into MI (n=111) and non-MI (n=2,278) groups according to the presence of MI during hospitalization. As a subanalysis, the patients were assigned to CVA (n=97) and non-CVA (n=2,292) and PE (n=54) and non-PE (n=2,335) groups. The primary outcome was long-term survival after discharge. During a median follow-up period of 2.4years after discharge, 30 patients (27.0%) in the MI group and 140 patients (6.2%) in the non-MI group died (p <0.001). The Kaplan-Meier survival curve analysis demonstrated that the MI group was significantly associated with an increased incidence of all-cause death after discharge (log-rank p <0.001), as supported by the multivariate Cox proportional hazards model analysis (hazard ratio [HR] 2.45, 95% confidence interval [CI] 1.61 to 3.74, p <0.001). However, the presence of CVA (HR 1.46, 95% CI 0.91 to 2.34, p=0.113) or PE (HR 0.94, 95% CI 0.23 to 3.84, p=0.937) were not associated with an increased incidence of all-cause death after discharge. In conclusion, among the cardiovascular and cerebrovascular complications associated with COVID-19 hospitalization, the presence of MI during hospitalization was proved to be a significant independent predictor of long-term mortality in patients who survived COVID-19 hospitalization.

Pulmonary embolism induces pneumonia-like lung injury beyond pulmonary infarction.

Patients with pulmonary embolism (PE) commonly manifest concomitant "pneumonia," which is generally believed to be either a cause (infection) or a consequence (infarction) of PE. This study aimed to clarify the relationship between PE and "pneumonia-like" lesions beyond pulmonary infection and infarction. Chest computed tomography (CT) images of patients with PE and deep vein thrombosis (DVT) were retrospectively analyzed to compare the incidence of pneumonia lesions. The pathological damage and wet/dry ratio of lung tissues were observed in PE rats and PE plasma-injected rats. In total, 793 and 914 inpatients were enrolled in the PE and DVT groups, respectively. Pneumonia lesions were observed in 36.9% and 26.3% of patients in the PE and DVT groups, respectively (p < 0.0001). Among PE rats, 33.3% exhibited focal severe lung injury, which closely resembled the pathological damage of community-acquired pneumonia. The wet/dry ratio was significantly higher in the PE group than in the PE-control group (4.98 ± 0.08 vs. 4.39 ± 0.06, p < 0.0001). Among PE plasma-injected rats, individuals with focal proven lung injury were found at all experimental points, with an incidence of 27.6%. The lung wet/dry ratio was significantly higher in the PE plasma group than in the PE-control plasma group at 1 and 2 h postinjection (5.02 ± 0.12 vs. 4.61 ± 0.06 and 4.76 ± 0.16 vs. 4.34 ± 0.09, respectively; p < 0.05). In conclusion, the manifestation of pneumonia lesions in chest CT images was higher among PE patients than among DVT patients. Plasma of PE rats could induce focal pneumonia-like lung injury in healthy rats.

Serum Sema7A is increased in patients with acute aortic dissection

ABSTRACT Background To observe the level of serum Sema7A in acute aortic dissection (AAD) and its diagnostic value for AAD. Research design and methods Patients with sudden chest pain including AAD, acute myocardial infarction (AMI) or pulmonary embolism (PE) were enrolled. Patients without chest pain or cardiovascular diseases were included as the controls. Serum Sema7A and plasma D-dimer were detected and compared in each group. Results 85 AAD patients, 55 AMI patients, 15 PE patients, and 30 controls were enrolled. The concentration of Serum Sema7A in the AAD group was significantly higher than that in the control, AMI and PE group. Serum Sema7A was positively correlated with D-dimer. In AAD patients who underwent invasive intervention therapy, serum Sema7A levels were significantly decreased after the intervention. Serum Sema7A was an independent risk factor for the presence of AAD. The areas under the ROC curve of Sema7A and D-dimer for differential diagnosis of AAD from other chest pain disorders were 0.842 (0.776, 0.909) and 0.788 (0.714, 0.862), respectively. Conclusions Sema7A is highly expressed in patients with AAD. Sema7A might be a valuable biomarker for the early diagnosis of AAD and has the potential to differentiate AAD from AMI and PE.

Predicting acute pulmonary embolism in COVID-19.

Acute pulmonary embolism (PE) is a life-threatening condition in patients with Coronavirus disease-2019 (COVID-19). Computed tomography pulmonary angiography is the preferred test to confirm the diagnosis. However, computed tomography pulmonary angiography is expensive and is not available in every clinic. This study aimed to determine whether clinical findings, symptoms, and parameters that are cost-effective and available in many clinics such as C-reactive protein (CRP) lymphocyte ratio (CLR), and ferritin CRP ratio (FCR) can be used in the diagnosis of PE in patients with COVID-19. Out of the reviewed files, 127 patients were diagnosed with PE, whereas 105 patients had no PE. At the first admission, laboratory parameters, complaints, respiratory rate, and percent oxygen saturation in the blood (SpO2) with a pulse oximeter were recorded for each patient. Eosinophil levels remained lower, whereas ferritin lymphocyte ratio and CLR were higher in the PE group. Patients with more elevated ferritin, CRP, and CLR had an increased mortality risk. Shortness of breath and tiredness was more common in the PE group. A decrease in eosinophil levels, whereas an increase in CLR, D-dimer, and CRP may predict PE. Elevated CLR is highly predictive of PE and is associated with increased mortality risk. COVID-19 patients with a CLR level above 81 should be investigated for PE.

Pulmonary embolism post-Covid-19 infection: physiopathological mechanisms and vascular damage biomarkers

Covid-19 infection is characterized by several acute complications, as well long-term sequelae, mostly sustained by endothelial dysfunction; several studies show that complications as pulmonary embolism (PE) are described both in the acute phase and after negativization. Aim of research was to evaluate anthropometric, bio-humoral, instrumental parameters in a group of patients affected by PE after recent Covid-19 infection compared to PE patients without previous Covid-19 infection. We enrolled 72 consecutive patients (35M, 37F) with acute PE, distinguished in relation to previous acute Covid-19 infection: 54 pts without previous acute Covid-19 infection and 18 pts with previous Covid-19 infection within negativity at least 2 months before PE diagnosis; 44 healthy subjects (21M, 23F) were recruited as control group. Patients who had previously developed Covid-19 needed hospitalization in high percentage (84%); this group showed significantly higher prevalence of diabetes mellitus than Covid-19-free PE patients, reduced serum levels of C-reactive protein, sST2 and PESI score. In post-Covid-19 PE group, we observed higher mean IMPROVE risk score, whereas in Covid-19-free group lower P/F ratio, higher radiological severity, and worse PESI score and severity index. Covid-19 infection affects not just the lung parenchyma but also other organs; endothelial damage plays pivotal role in long-term alterations; in high thrombotic risk group (recent hospitalization due to acute Covid-19 infection), we have described thrombotic complications characterized by persistent prothrombotic state after recovery, highlighted by well-known markers as PCR and D-Dimer as well as novel vascular marker (sST2).

Clinical presentations of acute pulmonary embolism: A retrospective cohort study.

We aimed to investigate whether the unusual clinical presentation of pulmonary embolism (PE) varies by the type of provocation. In this retrospective cohort study, we examined the electronic health records (EHR) records of all patients diagnosed with PE (upon presentation or during hospitalization) presented to our tertiary hospital during 2014 to 2019. Inclusion criteria were the diagnosis of acute PE and age above 18 years. Excluded were all patients to whom complete EHR were not available. The primary outcome was the main presenting symptom, categorized by a multidisciplinary consensus expert committee as either typical or atypical of PE. Comorbidities, vital signs, medications and laboratory results on presentations were recorded. 591 patients were included in the final analysis. Dyspnea was significantly less common and hemoptysis and chest pain more common in the unprovoked PE group (35%, 5%, and 25%, respectively) compared with nonmalignant (42.6%, 0%, and 16.3%) and malignancy-associated (47.7%, 0.9%, and 8.2%) PE (Pv = 0.02, 0.002 and 0.001, respectively). No recorded symptoms were the third most common presentation overall, accounting for a significantly (Pv < 0.001) higher proportion of PE patients with malignancy (19%) whereas atypical presentation was the hallmark of patients with nonmalignant provokation (19.7%) (Pv = 0.005). Accounting for multiple potential confounders, the risk of atypical or asymptomatic presentation was higher with lower heart rates (RR = 0.974 95%C.I. [0.957-0.990]) and higher pulse oximetry saturation (RR = 1.114 95%CI [1.034-1.201]). The clinical presentation of PE varies with different types of provoking factors, with atypical presentation most common in nonmalignant provocation and asymptomatic presentation most prevalent in patients with underlying malignancy. Further studies are needed to determine the effect of said variance on long term clinical outcomes.

Evaluation of CT angiography obstruction score and pulmonary perfusion defect score using the third-generation dual-source CT for pulmonary embolism

Aim To investigate the application value of computed tomography (CT) angiography (CTA) obstruction score and pulmonary perfusion defect score on the third-generation dual-source CT for pulmonary embolism and the changes of the right ventricular function. Materials And Methods The clinical data of 52 patients with pulmonary embolism (PE) confirmed using the third-generation dual-source dual-energy CTPA were analysed retrospectively. These patients were divided into the severe group and non-severe group according to their clinical manifestations. The results of CTPA and dual-energy pulmonary perfusion imaging (DEPI) were recorded by two radiologists for index computation. The ratio of the maximum short-axis diameter of the right ventricle (RV) to that of the left ventricle (LV) was also recorded. The correlation analysis between RV/LV and the mean values of CTA obstruction score and perfusion defect score was performed. Correlation analysis and agreement analysis were performed on the data measured by two radiologists, CTA obstruction score, and pulmonary perfusion defect score. Results CTA obstruction score and perfusion defect score measured by the two radiologists had good correlation and agreement. CTA obstruction score, perfusion defect score, and RV/LV were significantly lower in the non-severe group than in the severe PE group. RV/LV had a significant positive correlation with CTA obstruction score and perfusion defect score (p<0.05). Conclusion The third-generation dual-source dual-energy CT plays a positive role in assessing PE severity and RV function and can provide additional information for the clinical management and treatment of PE patients.

Changes and significance of vascular endothelial injury markers in patients with diabetes mellitus and pulmonary thromboembolism

BackgroundTo investigate the changes and clinical significance of vascular endothelial injury markers in type 2 diabetes mellitus (T2DM) complicated with pulmonary embolism (PE).MethodsThis prospective study enrolled patients with T2DM hospitalized in one hospital from January 2021 to June 2022. Soluble thrombomodulin (sTM) (ELISA), von Willebrand factor (vWF) (ELISA), and circulating endothelial cells (CECs) (flow cytometry) were measured. PE was diagnosed by computed tomography pulmonary angiography (CTPA).ResultsThirty participants were enrolled in each group. The plasma levels of sTM (151.22 ± 120.57 vs. 532.93 ± 243.82 vs. 1016.51 ± 218.00 pg/mL, P < 0.001) and vWF (9.63 ± 2.73 vs. 11.50 ± 2.17 vs. 18.02 ± 3.40 ng/mL, P < 0.001) and the percentage of CECs (0.17 ± 0.46 vs. 0.30 ± 0.08 vs. 0.56 ± 0.18%, P < 0.001) gradually increased from the control group to the T2DM group to the T2DM + PE group. sTM (OR = 1.002, 95%CI: 1.002–1.025, P = 0.022) and vWF (OR = 1.168, 95%CI: 1.168–2.916, P = 0.009) were associated with T2DM + PE. sTM > 676.68 pg/mL for the diagnosis of T2DM + PE achieved an AUC of 0.973, while vWF > 13.75 ng/mL achieved an AUC of 0.954. The combination of sTM and vWF above their cutoff points achieved an AUC of 0.993, with 100% sensitivity and 96.7% specificity.ConclusionsPatients with T2DM show endothelial injury and dysfunction, which were worse in patients with T2DM and PE. High sTM and vWF levels have certain clinical predictive values for screening T2DM accompanied by PE.