Risk Factors For Embolism Research Articles

Left iliac vein involvement is a protective factor against symptomatic pulmonary embolism in lower left extremity deep vein thrombosis

ObjectiveLeft iliac vein compression is associated with left iliac vein thrombosis (IVT), potentially limiting the migration of the thrombus from this stenotic segment to the pulmonary arteries. We sought to investigate the differences in clinical characteristics and risk factors of symptomatic pulmonary embolism (SPE) in patients with deep vein thrombosis (DVT) in different limbs and anatomical locations. MethodsA retrospective analysis was conducted of 1476 patients with acute unilateral lower extremity DVT. Differences of clinical characteristics and risk factors between left-sided and right-sided DVT, IVT, and non-IVT, cases with SPE and cases without SPE were compared. Risk factors for SPE were investigated using logistic regression analysis. ResultsSPE was more common in patients with right-sided DVT than patients with left-sided DVT (13.8% vs 7.0%; P < .001). SPE incidence in left IVT (5.4%) was lower than that in left non-IVT, right IVT, and right non-IVT (12.8%, 10.1%, 16.6%, respectively; P < .001). There was no difference in SPE incidence among patients with left non-IVT, right IVT and right non-IVT (P > .05). In patients with left-sided DVT, male sex was associated with an increased odds of SPE (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.10-2.85; P = .02). IVT, surgery, and immobilization were associated with a decreased odds of SPE (OR, 0.46 [95% CI, 0.28-0.76; P < .01]; OR, 0.55 [95% CI, 0.32-0.95; P = .03]; and OR, 0.53 [95% CI, 0.32-0.86; P = .01]). In patients with right-sided DVT, provoked DVT was associated with a decreased odds of SPE (OR, 0.50; 95% CI, 0.27-0.93; P = .03). ConclusionsLeft IVT is associated with a lower SPE incidence than right-sided DVT. Left IVT and may be a relative protective factor against SPE.

Clinical characteristics and thrombotic risk of atrial fibrillation with obstructive sleep apnea: results from a multi-center atrial fibrillation registry study

BackgroundSleep apnea is a risk factor for atrial fibrillation (AF) but it is underdiagnosed. Whether obstructive sleep apnea (OSA) is correlated with thrombotic risk in AF remains unclear. The aim of the present study was to analyze the clinical characteristics and assess the thrombotic risk of AF with OSA.MethodsIn the present registry study,1990 consecutive patients with AF from 20 centers were enrolled. The patients were divided into 2 groups depending on whether they presented with both AF and OSA. All the patients were followed up for 1 year to evaluate the incidences of stroke and non-central nervous system (CNS) embolism.ResultsOf the 1990 AF patients, 70 (3.5%) and 1920 (96.5%) patients were in the OSA group and non-OSA group, respectively. The results of the multivariate logistic model analysis showed that male sex, body mass index (BMI), smoking, and major bleeding history were independent risk factors for patients with AF and OSA. The comparison of the Kaplan–Meier curves using the log-rank test revealed that AF with OSA was correlated with an increased risk of non-CNS embolism (p < 0.01). After multivariate adjustments were performed, OSA remained an independent risk factor for non-CNS embolism (HR 5.42, 95% CI 1.34–22.01, p = 0.02), but was not correlated with the risk of stroke in patients with AF.ConclusionsThe present study revealed that male sex, high BMI values, smoking, and major bleeding history were independent risk factors for patients with AF and OSA. Moreover, OSA was an independent risk factor for non-CNS embolism in AF. Our results indicate that non-CNS embolism requires focus in patients with AF and OSA.

Risk of Venous Thromboembolic Complications in Patients with Atrial Fibrillation: a Systematic Review and Meta-analysis

Aim: The aim of this meta-analysis and systematic review was to evaluate the possible connection between AF and VTE.Material and methods. Atrial fibrillation (AF) and atrial flutter (AFL) contribute to intra-atrial blood stasis which leads to thrombus formation with its embolization. There is some evidence that AF can be a risk factor for deep vein thrombosis (DVT) and pulmonary embolism (PE). The following databases were searched: PubMed (MEDLINE), EMBASE, Google Scholar, the Cochrane Central Register of Controlled Trials. The time frame for conducting a systematic literature search ranged from January 1, 1990 to November 1, 2021. The diagnosis of atrial fibrillation had to be confirmed by using ECG. The diagnosis of VTE could be made with Doppler imaging, ventilation/perfusion scan, CT angiography, venography, angiography or autopsy. Only the three studies with 102192 patients meeting the requirement were included in the meta-analysis.Results. The prevalence of DVT and PE were assessed using incidence rate ratios (IRR) method of the inverse variance random effects model and its 95% confidence interval (CI). The significant association between atrial fibrillation and pulmonary embolism was found (IRR, 4.18 95% Cl 1.958.98). Also there is obvious association between DVT and AF (IRR, 2.97 95% Cl 2.18-4.03).Conclusion. It can be concluded that the increased risk of developing VTE is associatedwith concomitant AF.

Analysis of risk factors for venous air embolism in the semisitting position and its impact on outcome in a consecutive series of 740 patients.

Routine use of the semisitting position, which offers several advantages, remains a matter of debate. Venous air embolism (VAE) is a potentially serious complication associated with the semisitting position. In this study, the authors aimed to investigate the safety of the semisitting position by analyzing data over a 20-year period. The incidence of VAE and its perioperative management were analyzed retrospectively in a consecutive series of 740 patients who underwent surgery between 1996 and 2016. The occurrence of VAE was defined by detection of bubbles on transthoracic Doppler echocardiography (TTDE) or transesophageal echocardiography (TEE) studies, a decrease of end-tidal CO2 (ETCO2) by 4 mm Hg or more, and/or an unexplained drop in systolic arterial blood pressure (≥ 10 mm Hg). From 1996 until 2013 TTDE was used, and from 2013 on TEE was used. The possible risk factors for VAE and its impact on surgical performance were analyzed. There were 404 women and 336 men with a mean age at surgery of 49 years (range 1-87 years). Surgery was performed for infratentorial lesions in 709 patients (95.8%), supratentorial lesions in 17 (2.3%), and cervical lesions in 14 (1.9%). The most frequent pathology was vestibular schwannoma. TEE had a higher sensitivity than TTDE. While TEE detected VAE in 40.5% of patients, TTDE had a detection rate of 11.8%. Overall, VAE was detected in 119 patients (16.1%) intraoperatively. In all of these patients, VAE was apparent on TTDE or TEE. Of those, 23 patients also had a decrease of ETCO2, 18 had a drop in blood pressure, and 23 had combined decreases in ETCO2 and blood pressure. VAE was detected in 24% of patients during craniotomy before opening the dura mater, in 67% during tumor resection, and in 9% during wound closure. No risk factors were identified for the occurrence of VAE. Two patients had serious complications due to VAE. Surgical performance in vestibular schwannoma surgery was not affected by the presence of VAE. This study shows that the semisitting position is overall safe and that VAE can be managed effectively. Persistent morbidity is very rare. The authors suggest that the semisitting position should continue to have a place in the standard armamentarium of neurological surgery.

Clinical characteristics and risk factors predictive of pulmonary embolism complicated in bronchiectasis patients: a retrospective study

ObjectivePulmonary embolism (PE) is a rare complication in bronchiectasis (BE) patients associated with a high rate of mortality and morbidity. However, data regarding bronchiectasis patients complicated with PE are limited. Early diagnosis of PE in bronchiectasis patients can improve the prognosis, this study aimed to investigate the clinical features and potential risk factors for early diagnosis of PE in bronchiectasis patients.Methods Data of Patients were collected from Tongji Hospital of Tongji University of China. Bronchiectasis patients complicated with pulmonary embolism were named as BE/PE group (n = 63), as well as contemporaneous aged- and sex-matched bronchiectasis patients without pulmonary embolism named as BE group (n = 189), at a ratio of 1:3(cases to controls). Clinical parameters and risk factors were analyzed.ResultsUnivariate analysis shows that long-term bed rest, chronic lung disease, autoimmune disease, peripheral artery disease (PAD), tuberculosis history, dyspnea, blood homocysteine, CD4/CD8 ratio, or SIQIIITIII syndrome were closely correlated with the incidence of PE in the bronchiectasis patients (p < 0.05). Multivariate logistic regression analysis of significant variables showed that CD4/CD8 ratio (OR 1.409, 95% CI 1.045–1.901) and autoimmune disease (OR 0.264, 95% CI 0.133–0.524) are independent risk factors for BE/PE patients, compared with the BE patients. 53 out of 189 (28.0%) BE patients had hemoptysis, and 15 out of 63 (23.8%) BE/PE patients had hemoptysis (p > 0.05).ConclusionsThe coexistence of pulmonary embolism and bronchiectasis are rarely encountered and easily to be ignored. Early identification of the clinical characteristic and potential risk factors of pulmonary embolism in bronchiectasis patients may help optimize the treatment strategies.

Study on Litigation-expertise of Sudden Pulmonary Embolism for Laparoscopic Inguinal Hernia — Case Report and Literature Review

With the development of new concepts and technologies of laparoscopic diagnosis and treatment, inguinal hernia repair is increasingly and widely used in clinical practice, and accordingly, the corresponding complications of deep vein thrombosis have also attracted clinical attention. Deep-venous thrombosis and pulmonary embolism have become one of the potential and very dangerous serious complications in patients with inguinal hernia. One case of sudden pulmonary embolism shortly after the laparoscopic inguinal hernia repair was reported in this paper, the patient has been trapped in a persistent plant survival state after rescue. The patient was a male, 67-year-old patient with up to 4 hours of operation, and no available clinical evidences about operative vascular injury have been found, however, this case have been triggered a civil lawsuit for medical damages and the filing of a judicial expertise. Combined with the disputes of this case and the results of the technical review, the legal related preoperative notification and informed consent, the requirements and functions of working system before operation, the preoperative examination and the related surgical risk-factors of pulmonary embolism are discussed. It is suggests that the preoperative discussion, preoperative examination and preoperative notification of laparoscopic inguinal hernia should be paid great attention to in clinical work, and form an institutionalized and normative workflow, which plays an important role in effectively controlling the operation time, reducing surgical complications and avoiding medical disputes.

Clinical Study on Treatment of Acute Lower Extremity Arterial Embolism With Straub Thrombus Removal System.

BackgroundAcute lower extremity arterial embolism (ALEAE) is a common and frequently occurring disease in clinics. Although thrombectomy with arteriotomy has been widely used and developed in clinics, there is a high probability of embolic recurrence after operation. The present study investigated the clinical efficacy of the Straub Rotarex system in the treatment of ALEAE, as it could remove exfoliative substances in acute and chronic cavities and expose diseased vessels.Materials and MethodsWe accessed our institutional database and retrospectively screened all patients with ALEAEs who received surgical treatment between April 2018 and April 2021. To observe the clinical efficacy, surgical indicators, incidence of postoperative complications, and recurrence rate of treatment with Straub Rotarex system and arteriotomy thrombectomy and analyze the risk factors for recurrence of embolism after treatment with Straub Rotarex system by multivariate Logistic regression model.ResultsFinally, 64 patients were included as the research object. The total effective rates of the observation group and the control group after operation were 100 and 93.75% respectively, and there was no significant difference between the two groups (P > 0.05). The intraoperative blood loss, postoperative off-bed time and hospital stay time in the observation group were significantly lower than those in the control group, and the operation time and hospitalization expenses were significantly higher than those in the control group (P < 0.05). The incidence of postoperative complications in the observation group was 3.13%, which was significantly lower than 18.76% of that in the control group (P < 0.05). The recurrence rates of the observation group and the control group were 15.63 and 18.76%, respectively. There was no significant difference in the recurrence rate between the two groups (P > 0.05). Atrial fibrillation was an independent risk factor for recurrence after the Straub thrombus removal system (P < 0.05).ConclusionStraub thrombus removal system is an effective method for the treatment of ALEAE. Although it prolongs the operation time and increases the operation cost as compared with thrombectomy, it effectively improves the operation safety, postoperative life quality, and postoperative recovery, thus, worthy of clinical promotion. Atrial fibrillation is an independent risk factor for recurrent embolism after the Straub thrombus removal system. Paying attention to the clinical diagnosis and treatment of patients with atrial fibrillation is of great significance for patients to choose a reasonable treatment, prevent a recurrence, and improve the prognosis.

Fatal amniotic fluid embolism: incidence, risk factors and influence on perinatal outcome.

This study aimed to estimate the incidence of fatal amniotic fluid embolism, describe its risk factors, and analyze perinatal outcomes. Maternity cases and newborn records of amniotic fluid embolism were collected from the Zhejiang Maternal Surveillance System from October 2006 to October 2019. This study strictly limited the diagnostic criteria for AFE and excluded suspicious cases in order to minimize false-positive AFE cases. The risk factors of fatal amniotic fluid embolism and the relationship between perinatal prognosis and AFE were investigated using logistic regression analysis, estimating the adjusted odds ratios (aORs) and 95% confidence intervals (CIs). 149 cases of amniotic fluid embolism were registered, of which 80 cases were fatal. The estimated fatal AFE incidence was 0.99 per 100,000. The occurrence of fatal AFE was significantly correlated with spontaneous vaginal delivery (aOR 12.3, 95% CI 3.3-39.2) and cardiac arrest (aOR 64.8, 95% CI 14.6-287.8). The average diagnosis time of fatal AFE is 85.51min, and the peak period of female death is 1-12h after the onset of the disease, accounting for 60% (48/80) of cases. Fatal amniotic embolism is a cause of intrauterine fetal death and fetal death during delivery (aOR 11.957, 95% CI 1.457-96.919; aOR 13.152, 95% CI 1.636-105.723). Of the 149 confirmed AFE cases, 11 cases of stillbirth occurred, 12 cases were stillborn, and 7 cases of neonatal death were reported. The perinatal mortality rate was 202 per 1000. Early detection, diagnosis, and treatment of amniotic fluid embolism are essential to avoiding fatal AFE. Clinicians should fully evaluate the pros and cons of choosing the delivery method for pregnant women. When cardiac arrest occurs in women with amniotic fluid embolism, obstetricians should be particularly careful and provide timely and effective treatment to minimize the fatality rate. The outcome of AFE is not only related to maternal survival but also plays a decisive role in the prognosis of the infant over the perinatal period.

Risks of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19: nationwide self-controlled cases series and matched cohort study

ObjectiveTo quantify the risk of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19.DesignSelf-controlled case series and matched cohort study.SettingNational registries in Sweden.Participants1 057 174 people who tested positive for SARS-CoV-2 between 1 February 2020 and 25 May 2021 in Sweden, matched on age, sex, and county of residence to 4 076 342 control participants.Main outcomes measuresSelf-controlled case series and conditional Poisson regression were used to determine the incidence rate ratio and risk ratio with corresponding 95% confidence intervals for a first deep vein thrombosis, pulmonary embolism, or bleeding event. In the self-controlled case series, the incidence rate ratios for first time outcomes after covid-19 were determined using set time intervals and the spline model. The risk ratios for first time and all events were determined during days 1-30 after covid-19 or index date using the matched cohort study, and adjusting for potential confounders (comorbidities, cancer, surgery, long term anticoagulation treatment, previous venous thromboembolism, or previous bleeding event).ResultsCompared with the control period, incidence rate ratios were significantly increased 70 days after covid-19 for deep vein thrombosis, 110 days for pulmonary embolism, and 60 days for bleeding. In particular, incidence rate ratios for a first pulmonary embolism were 36.17 (95% confidence interval 31.55 to 41.47) during the first week after covid-19 and 46.40 (40.61 to 53.02) during the second week. Incidence rate ratios during days 1-30 after covid-19 were 5.90 (5.12 to 6.80) for deep vein thrombosis, 31.59 (27.99 to 35.63) for pulmonary embolism, and 2.48 (2.30 to 2.68) for bleeding. Similarly, the risk ratios during days 1-30 after covid-19 were 4.98 (4.96 to 5.01) for deep vein thrombosis, 33.05 (32.8 to 33.3) for pulmonary embolism, and 1.88 (1.71 to 2.07) for bleeding, after adjusting for the effect of potential confounders. The rate ratios were highest in patients with critical covid-19 and highest during the first pandemic wave in Sweden compared with the second and third waves. In the same period, the absolute risk among patients with covid-19 was 0.039% (401 events) for deep vein thrombosis, 0.17% (1761 events) for pulmonary embolism, and 0.101% (1002 events) for bleeding.ConclusionsThe findings of this study suggest that covid-19 is a risk factor for deep vein thrombosis, pulmonary embolism, and bleeding. These results could impact recommendations on diagnostic and prophylactic strategies against venous thromboembolism after covid-19.

Atrial Embolization after a Transcatheter Mitral Valve Replacement

Atrial Embolization after a Transcatheter Mitral Valve Replacement

Massive Saddle Pulmonary Embolism in a Preterm Neonate With Successful Emergent Open Embolectomy

Pulmonary embolism in the neonate is a rare, life-threatening emergency. Risk factors for neonatal pulmonary embolism (PE) include sepsis, asphyxia, prematurity, and vascular catheterisation. We report the case of a preterm neonate with a massive saddle pulmonary thrombosis of unidentified etiology. Prompt diagnosis by cardiology allowed an emergent lifesaving open surgical thrombectomy, underscoring the importance of efficient multidisciplinary teamwork. Pediatric health-care professionals must be aware of this rare entity when initial oxygen desaturation management fails, even when obvious risk factors for PE are not apparent. We emphasise the importance of seamless multidisciplinary communication and proactive surgical consultation.

A Case of Acute Pulmonary Embolism after Catheter Radiofrequency Ablation of Paroxysmal Supraventricular Tachycardia

Radiofrequency ablation is an effective method to treat paroxysmal supraventricular tachycardia. In this article, we report a case of pulmonary embolism and death after ablation of paroxysmal supraventricular tachycardia. The patient did not have other diseases, nor did he have any risk factors for embolism. A summary of the literature found that despite the low incidence, radiofrequency ablation for paroxysmal supraventricular tachycardia is still associated with the risk of pulmonary embolism. At present, there is no clear guidance for the perioperative anticoagulation treatment of such patients. It is necessary to investigate this issue in depth in the future.

Risk factors of pulmonary embolism in the elderly patients: a retrospective study.

We aimed to summarize the clinical feature and risk factors of patients suffering from pulmonary embolism (PE) in the elderly patients, and explore the change in D-dimer after anti-coagulant therapy. A total of 426 patients with PE admitted from August 2012 to January 2019 in the Cangzhou Central Hospital were analyzed in this retrospective study. A comparison of clinical features and risk factors was conducted between the elderly group and non-elderly groups. Blood levels of D-dimer, C-reactive protein (CRP), tumor necrosis factor-α and interferon-γ were measured before and 3days after anti-coagulant therapy in two groups. The most important risk factor for the elderly patients was stroke, while for non-elderly patients was deep vein thrombosis (DVT). After anti-coagulant therapy, the decreasing level of D-dimer and CRP showed statistically significant differences between the two groups. Between the elderly and non-elderly groups, the main clinical manifestations were similar. The risk factors of elderly patients were chronic obstructive pulmonary disease, malignant tumor, DVT and stroke. After anti-coagulant therapy, the content of D-dimer was lower than 3days ago. Blood levels of D-dimer and CRP may be potent screening markers for PE especially among elderly patients.

Outcomes of Acute Pulmonary Embolism in Patients With Schizophrenia Spectrum Disorders

Schizophrenia is increasingly recognised as an important risk factor for pulmonary embolism (PE). This study aims to describe the characteristics of patients with schizophrenia who develop PE, and describe their outcomes following acute PE.

Cavitary Pulmonary Infarction Mimicking Koch’s Disease

Pulmonary infarction (PI), defined as localized destruction (necrosis) of lung tissue due to obstruction of the arterial blood supply by an embolus, is a rare condition because of the dual blood supply of the lungs. It occurs more in elderly patients who typically have associated co-morbidities, such as chronic heart and lung disease, which affect blood circulation. Pulmonary infarction may present with chest pain, fast breathing, blood tinged cough and fever, resembling more common conditions such as bacterial pneumonia and tuberculosis. High index of suspicion is required for early diagnosis of this condition as mortality from this condition can be as high as 70%. We present a case of cavitary pulmonary infarction in a middle-aged female with no major risk factors for pulmonary embolism who was initially managed as a case of pulmonary tuberculosis. The clinical presentation, pathogenesis, imaging findings and management of PI have also been discussed. The purpose of this report is to increase the awareness of this less common condition among clinicians and highlight the radiologic differences between PI and the more common inflammatory diseases of the lung.

Silent Pulmonary Embolism in Deep Vein Thrombosis: Relationship and Risk Factors.

PurposeThis study aimed to evaluate risk factors for silent pulmonary embolism (PE) in symptomatic deep vein thrombosis (DVT) and investigate the relationship between DVT and silent PE.MethodsThis was a single-centre, retrospective cohort study. Between 5 January 2015 and 31 December 2021, consecutive patients with symptomatic DVT received CT pulmonary angiography and CT venography were analyzed. Patient demographics, comorbidities, risk factors, and image findings were analyzed. The group differences were compared using a Chi-square test, Fisher's exact test, independent t test, or Mann-Whitney U test. Multivariant regression was used to determine predictive factors for silent PE.ResultsA total of 355 patients (mean age, 60.5 ± 16.6 years) were included. The incidence of silent PE was 43.1%. The main or lobar pulmonary arteries were affected in 53.6% of patients, which is more often found in iliofemoral DVTs (56.6% vs 26.7%, p = .027). The multivariant analysis showed male patients (p = .042; OR 1.59; 95% CI, 1.02–2.50), inferior vena cava involvement (p = .043; OR 1.81; 95% CI, 1.02–3.20) and D-dimer value > 3.82 μg/ml (p < .001; OR 2.32; 95% CI, 1.43–3.77) were risk factors for silent PE. Unilateral DVT patients with ipsilateral iliac vein compression had a lower incidence of silent PE (28.8% vs 52.9%, p < .001).ConclusionIliofemoral DVT was associated with a more proximal PE. The male patients, inferior vena cava involvement, and D-dimer > 3.82 μg/ml were risk factors for silent PE. Ipsilateral iliac vein compression reduced the incidence of silent PE.

Risk Factors for Pulmonary Embolism in ICU Patients: A Retrospective Cohort Study from the MIMIC-III Database.

Pulmonary embolism (PE) is a common and potentially lethal form of venous thromboembolic disease in ICU patients. A limited number of risk factors have been associated with PE in ICU patients. In this study, we aimed to screen the independent risk factors of PE in ICU patients that can be used to evaluate the patient's condition and provide targeted treatment. We performed a retrospective cohort study using a freely accessible critical care database Medical Information Mart for Intensive Care (MIMIC)-III. The ICU patients were divided into two groups based on the incidence of PE. Finally, 9871 ICU patients were included, among which 204 patients (2.1%) had pulmonary embolism. During the multivariate logistic regression analysis, sepsis, hospital_LOS (the length of stay in hospital), type of admission, tumor, APTT (activated partial thromboplastin time) and platelet were independent risk factors for patients for PE in ICU, with OR values of 1.471 (95%CI 1.001-2.162), 1.001 (95%CI 1.001-1.001), 3.745 (95%CI 2.187-6.414), 1.709 (95%CI 1.247-2.341), 1.014 (95%CI 1.010-1.017) and 1.002 (95%CI 1.001-1.003) (Ps < 0.05). ROC curve analysis showed that the composite indicator had a higher predictive value for ICU patients with PE, with a ROC area under the curve (AUC) of 0.743 (95%CI 0.710 -0.776, p < 0.001). Finally, sepsis, tumor, platelet count, length of stay in the hospital, emergency admission and APTT were independent predictors of PE in ICU patients.

Risk Factors for Pulmonary Cement Embolism (PCE) After Polymethylmethacrylate Augmentation: Analysis of 32 PCE Cases

ObjectivePulmonary cement embolism (PCE) is an underestimated but potentially fatal complication after cement augmentation. Although the treatment and follow-up of PCE have been reported in the literature, the risk factors for PCE are so far less investigated. This study aims to identify the preoperative and intraoperative risk factors for the development of PCE. MethodsA total of 1,373 patients treated with the polymethylmethacrylate (PMMA) augmentation technique were retrospectively included. Patients with PCE were divided into vertebral augmentation group and screw augmentation group. Possible risk factors were collected as follows: age, sex, bone mineral density, body mass index, diagnosis, comorbidity, surgical procedure, type of screw, augmented level, number of augmented vertebrae, fracture severity, presence of intravertebral cleft, cement volume, marked leakage in the paravertebral venous plexus, and periods of surgery. Binary logistic regression analyses were used to analyze independent risk factors for PCE. ResultsPCE was identified in 32 patients, with an incidence rate of 2.33% (32 of 1,373). For patients who had undergone vertebral augmentation, marked leakage in the paravertebral venous plexus (odds ratio [OR], 1.2; 95% confidence interval [CI], 0.1–10.3; p=0.000) and previous surgery (OR, 16.1; 95% CI, 4.2–61.0; p=0.007) were independent risk factors for PCE. Regarding patients who had undergone screw augmentation, the marked leakage in the paravertebral venous plexus (OR, 4.2; 95% CI, 0.5–37.3; p=0.004) was the main risk factor. ConclusionMarked leakage in the paravertebral venous plexus and previous surgery were significant risk factors related to PCE. Paravertebral leakage and operator experience should be concerned when performing PMMA augmentation.

NT Pro-BNP can be used as a risk predictor of clinical atrial fibrillation with or without left atrial enlargement.

BackgroundNT Pro‐BNP is a blood marker secreted by cardiomyocytes. Myocardial stretch is the main factor to stimulate NT Pro‐BNP secretion in cardiomyocytes. NT Pro‐BNP is an important risk factor for cardiac dysfunction, stroke, and pulmonary embolism. So does atrial myocyte stretching occur when patients have atrial fibrillation (AF)? Whether atrial muscle stretch induced by AF leads to increased NT Pro‐BNP remains unclear. The purpose of this study is to investigate the relationship between NT Pro‐BNP and AF.HypothesisAF can cause changes in myocardial tension. Changes in myocardial tension may lead to increased secretion of NT Pro‐BNP. We hypothesize that NT Pro‐BNP may increase in AF with or without LAD enlargement.MethodsThis clinical study is an observational study and has been approved by the Ethics Committee of the First Affiliated Hospital of Xi'an Jiaotong University. Ethical approval documents is attached. The study retrospectively reviewed 1345 patients with and without AF. After excluding 102 patients who were not eligible, the final total sample size was 1243 cases: AF group 679 patients (378, 55.7% males) and non‐AF group 564 patients (287, 50.8% males). NT Pro‐BNP was observed in AF group and non‐AF group with or without LAD. After adjusting for age, gender, BMI, left atrial diameter, hypertension, diabetes, coronary heart disease, and cerebral infarction, NT Pro‐BNP remains statistically significant with AF.ConclusionNT Pro‐BNP can be used as a risk predictor of AF with or without left atrial enlargement.

Vegetation Size, Multiplicity, and Position in Patients With Infective Endocarditis

BackgroundInfective endocarditis is a life-threatening condition and is associated with embolic events. We aimed to evaluate the association of vegetation size, multiplicity, and position with cerebral embolism and late mortality in patients with infective endocarditis. MethodsWe retrospectively reviewed patients with infective endocarditis who were admitted to a single institution between November 2005 and August 2017. A total of 419 patients with infective endocarditis were included in the study, 273 of whom had undergone surgery. The primary endpoint was all-cause mortality, and the secondary endpoint was cerebral embolism. Multivariate Cox regression and logistic regression analyses were performed to identify independent risk factors for 30-day mortality, late mortality, and cerebral embolism. ResultsAge (hazard ratio [HR] 1.02; 95% confidence interval [CI], 1.00 to 1.04), renal failure (HR 4.21; 95% CI, 2.67 to 6.65), surgery (HR 0.31; 95% CI, 0.21 to 0.46), and Acute Physiology and Chronic Health Evaluation II score (HR 1.08; 95% CI, 1.01 to 1.15) were associated with late mortality. Vegetation size, multiplicity, and position were not significantly associated with late mortality, but a mitral vegetation size of greater than 10 mm (odds ratio 2.25; 95% CI, 1.32 to 3.84) was an independent risk factor for cerebral embolism. ConclusionsA vegetation size of greater than 10 mm and the mitral position were found to be significant risk factors for cerebral embolism, and for this group, early surgery might be considered to prevent cerebral embolism.