scholarly journals Continuous Aspiration Thrombectomy in High- and Intermediate-High-Risk Pulmonary Embolism in Real-World Clinical Practice

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Aleksander Araszkiewicz ◽  
Sylwia Sławek-Szmyt ◽  
Stanisław Jankiewicz ◽  
Bartosz Żabicki ◽  
Marek Grygier ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Low Dose ◽  
Mechanical Thrombectomy ◽  
Arterial Oxygen Saturation ◽  
Clinical Status ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Arterial Oxygen ◽  
Pulmonary Artery Systolic Pressure

Objectives. We sought to assess the technical and clinical feasibility of continuous aspiration catheter-directed mechanical thrombectomy (CDT) in patients with high- or intermediate-high-risk pulmonary embolism (PE). Methods and Results. Fourteen patients (eight women and six men; age range: 29–71 years) with high- or intermediate-high-risk PE and contraindications to or ineffective systemic thrombolysis were prospectively enrolled between October 2018 and February 2020. The Indigo Mechanical Thrombectomy System (Penumbra, Inc., Alameda, California) was used as CDT device. Low-dose local thrombolysis (alteplase, 3–12 mg) was additionally applied in three patients. Technical and procedural success was achieved in 14 patients (100%). Complete or nearly complete clearance of pulmonary arteries was achieved in nine patients (64.3%), whereas partial clearance was achieved in five (35.7%). A significant improvement in the pre- and postprocedural patients’ clinical status was observed in the following fields (median; interquartile range): heart rate (110; 100–120/min vs. 85; 80–90/min; p < 0.0001 ), systolic blood pressure (106; 90–127 mmHg vs. 123; 110–133 mmHg; p = 0.049 ), arterial oxygen saturation (88.5; 84.2–93% vs. 95.0; 93.8–95%, p = 0.0051 ), pulmonary artery systolic pressure (55; 44–66 mmHg vs. 42; 34–53 mmHg; p = 0.0015 ), Miller index score (21.5; 20–23 vs. 9.5; 8–13; p < 0.0001 ) and right ventricular/left ventricular ratio (1.3; 1.3–1.5 vs. 1.0; 0.9–1.0; p < 0.0001 ). No major periprocedural bleeding was detected. Conclusions. CDT is a feasible and promising technique for management of high- or intermediate-high-risk PE to decrease thrombus burden, reduce right heart strain, and improve hemodynamic and clinical status. Some patients may benefit from simultaneous local low-dose thrombolytic therapy. Nevertheless, its criteria and role in CTD-managed patients require further elucidation.

scholarly journals A Single Imaging Modality in the Diagnosis, Severity, and Prognosis of Pulmonary Embolism

2014 ◽  
Vol 2014 ◽  
pp. 1-10
Author(s):  
Hadice Selimoglu Sen ◽  
Özlem Abakay ◽  
Mehmet Güli Cetincakmak ◽  
Cengizhan Sezgi ◽  
Süreyya Yilmaz ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Risk Evaluation ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Pulmonary Artery Systolic Pressure ◽  
Risk Of Death ◽  
Prediction Of Mortality ◽  
Increased Risk ◽  
Acute Pe

Introduction. This study aimed to investigate the currency of computerized tomography pulmonary angiography-based parameters as pulmonary artery obstruction index (PAOI), as well as right ventricular diameters for pulmonary embolism (PE) risk evaluation and prediction of mortality and intensive care unit (ICU) requirement.Materials and Methods. The study retrospectively enrolled 203 patients hospitalized with acute PE. PAOI was calculated according to Qanadli score.Results. Forty-three patients (23.9%) were hospitalized in the ICU. Nineteen patients (10.6%) died during the 30-day follow-up period. The optimal cutoff value of PAOI for PE 30th day mortality and ICU requirement were found as 36.5% in ROC curve analysis. The pulmonary artery systolic pressure had a significant positive correlation with right/left ventricular diameter ratio (r=0.531,P<0.001), PAOI (r=0.296,P<0.001), and pulmonary artery diameter (r=0.659,P<0.001). The patients with PAOI values higher than 36.5% have a 5.7-times increased risk of death.Conclusion. PAOI is a fast and promising parameter for risk assessment in patients with acute PE. With greater education of clinicians in this radiological scoring, a rapid assessment for diagnosis, clinical risk evaluation, and prognosis may be possible in emergency services without the need for echocardiography.

scholarly journals The Efficacy and Safety of Intermittent Low-Dose Urokinase Thrombolysis for the Treatment of Senile Acute Intermediate-High-Risk Pulmonary Embolism: A Pilot Trial

2018 ◽  
Vol 24 (7) ◽  
pp. 1067-1072 ◽  
Author(s):  
Tianming Zhao ◽  
Jixiang Ni ◽  
Xuehua Hu ◽  
Yingnan Wang ◽  
Xinge Du
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Low Dose ◽  
Troponin I ◽  
Heart Function ◽  
Pilot Trial ◽  
Left Ventricular ◽  
Bleeding Complications ◽  
Systolic Pulmonary Artery Pressure ◽  
The Uk

Thrombolysis and anticoagulation were the main treatment methods for acute pulmonary embolism. However, the use of thrombolysis drugs may lead to bleeding complications. We compared intermittent low-dose urokinase (UK) and alteplase (recombinant tissue plasminogen activator [rt-PA]) in normotensive patients with intermediate-high-risk pulmonary embolism. The UK group was treated with intravenous UK 10 000 U/kg once a day for 7 days. The rt-PA group was given alteplase 50 mg by intravenous injection within 2 hours of admission. After thrombolytic therapy, 48 patients were included in this trial. Compared with before treatment, right and left ventricular diastolic diameter ratio, systolic pulmonary artery pressure, and cardiac troponin I of the 2 groups all significantly decreased 8 and 14 days after treatment, which indicated that right heart function improved. Total efficacy rates for the UK group 8 and 14 days after treatment (79.2%, 87.5%) and the rt-PA group (75.0%, 91.67%) were not significantly different. Adverse bleeding reactions were higher in the rt-PA group (20.8%) than in the UK group (8.3%). This pilot study indicates that intermittent low-dose UK thrombolysis is equally effective as rt-PA. However, future large-scale studies must also determine whether small doses of UK thrombolysis reduce the risk of bleeding.

Abstract 14176: Pulmonary Effective Artery Elastance as a Novel Predictor of Adverse Events in Patients With Pulmonary Embolism

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hayaan Kamran ◽  
Essa Hariri ◽  
Jean-Pierre Iskandar ◽  
Aditya Sahai ◽  
Ihab haddadin ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Adverse Events ◽  
Pulmonary Artery ◽  
Troponin T ◽  
Systolic Pressure ◽  
Composite Endpoint ◽  
Severity Index ◽  
Pulmonary Artery Systolic Pressure ◽  
Hemodynamic Parameters

Introduction: Risk stratification tools including the Pulmonary Embolism Severity Index (PESI) and BOVA rely on complicated calculations that give less attention to hemodynamic parameters predictive of cardiogenic shock in acute pulmonary embolism (PE). We explored the possibility that simultaneous measurement of right sided and left sided non-invasive hemodynamic parameters by echocardiography may predict adverse sequelae in the context of acute PE. Methods: We retrospectively reviewed all Pulmonary Embolism Response Team (PERT) activations between 2014 and 2020. The PESI and BOVA scores were calculated and their performance in predicting adverse events was compared to pulmonary artery elastance (PAE). PAE (mmHg/mL) was calculated by dividing the Pulmonary Artery Systolic pressure (PASP) by the LV Stroke (SV). Blood biomarkers (troponin T, NT-proBNP, and lactate) were recorded. The composite primary outcome was: 1) need for advanced intervention, 2) cardiac arrest, and 3) in-hospital mortality. Multivariate and univariate regression was used to analyze outcomes. Results: 215 of 343 patients met inclusion criteria. Baseline characteristics were similar in patients with PAE <1 and PAE ≥ 1. PAE ≥ 1 was common in intermediate-high risk PE (85.7% vs 63.1%, p <0.001), with greater [NT-proBNP, pg/mL] (3599 vs 1427.5, p=0.001) and [lactate, mM] (2.9 vs 1.8. p=0.003). PAE ≥ 1 predicted the composite endpoint with odds ratio (OR) of 2.31 (95% CI 1.3-4.2, p=0.005), Comparatively BOVA had adjusted OR of 1.3 (95% CI, 1.1-1.6, p = 0.01) and PESI was not significant with OR of 1.4 (95% CI, 1 -2.1, p = 0.055) in predicting composite outcomes. Conclusion: In the context of acute high risk PE, PAE ≥ 1.0 is a novel and independent predictor of adverse cardiovascular events and mortality that should be prospectively validated.

scholarly journals Prognostic validation of partition values for quantitative parameters to grade functional tricuspid regurgitation severity by conventional echocardiography

2020 ◽  
Author(s):  
Denisa Muraru ◽  
Marco Previtero ◽  
Roberto C Ochoa-Jimenez ◽  
Andrada C Guta ◽  
Stefano Figliozzi ◽  
...  
Keyword(s):  
High Risk ◽  
Tricuspid Regurgitation ◽  
Nyha Class ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Pulmonary Artery Systolic Pressure ◽  
Threshold Values ◽  
Ventricular Ejection Fraction ◽  
Quantitative Parameters

Abstract Aims Quantitative echocardiography parameters are seldom used to grade tricuspid regurgitation (TR) severity due to relative paucity of validation studies and lack of prognostic data. To assess the relationship between TR severity and the composite endpoint of death and hospitalization for congestive heart failure (CHF); and to identify the threshold values of vena contracta width (VCavg), effective regurgitant orifice area (EROA), regurgitant volume (RegVol), and regurgitant fraction (RegFr) to define low, intermediate, and high-risk TR based on patients’ outcome data. Methods and results A cohort of 296 patients with at least mild TR underwent 2D, 3D, and Doppler echocardiography. We built statistical models (adjusted for age, NYHA class, left ventricular ejection fraction, and pulmonary artery systolic pressure) for VCavg, EROA, RegVol, and RegFr to study their relationships with the hazard of outcome. The tertiles of the derived hazard values defined the threshold values of the quantitative parameters for TR severity grading. During 47-month follow-up, 32 deaths and 72 CHF occurred. Event-free rate was 14%, 48%, and 93% in patients with severe, moderate, and mild TR, respectively. Severe TR was graded as VCavg &gt; 6 mm, EROA &gt; 0.30 cm2, RegVol &gt; 30 mL, and RegF &gt; 45%. Conclusion This outcome study demonstrates the prognostic value of quantitative parameters of TR severity and provides prognostically meaningful threshold values to grade TR severity in low, intermediate, and high risk.

Pulmonary transit of agitated contrast is associated with enhanced pulmonary vascular reserve and right ventricular function during exercise

2010 ◽  
Vol 109 (5) ◽  
pp. 1307-1317 ◽  
Author(s):  
André La Gerche ◽  
Andrew I. MacIsaac ◽  
Andrew T. Burns ◽  
Don J. Mooney ◽  
Warrick J. Inder ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Maximal Exercise ◽  
Arterial Oxygen Saturation ◽  
Maximal Oxygen Consumption ◽  
Systolic Pressure ◽  
Arterial Oxygen ◽  
Pulmonary Artery Systolic Pressure ◽  
Peak Exercise ◽  
Similar Proportion ◽  
Vascular Reserve

Pulmonary transit of agitated contrast (PTAC) occurs to variable extents during exercise. We tested the hypothesis that the onset of PTAC signifies flow through larger-caliber vessels, resulting in improved pulmonary vascular reserve during exercise. Forty athletes and fifteen nonathletes performed maximal exercise with continuous echocardiographic Doppler measures [cardiac output (CO), pulmonary artery systolic pressure (PASP), and myocardial velocities] and invasive blood pressure (BP). Arterial gases and B-type natriuretic peptide (BNP) were measured at baseline and peak exercise. Pulmonary vascular resistance (PVR) was determined as the regression of PASP/CO and was compared according to athletic and PTAC status. At peak exercise, athletes had greater CO (16.0 ± 2.9 vs. 12.4 ± 3.2 l/min, P < 0.001) and higher PASP (60.8 ± 12.6 vs. 47.0 ± 6.5 mmHg, P < 0.001), but PVR was similar to nonathletes ( P = 0.71). High PTAC (defined by contrast filling of the left ventricle) occurred in a similar proportion of athletes and nonathletes (18/40 vs. 10/15, P = 0.35) and was associated with higher peak-exercise CO (16.1 ± 3.4 vs. 13.9 ± 2.9 l/min, P = 0.010), lower PASP (52.3 ± 9.8 vs. 62.6 ± 13.7 mmHg, P = 0.003), and 37% lower PVR ( P < 0.0001) relative to low PTAC. Right ventricular (RV) myocardial velocities increased more and BNP increased less in high vs. low PTAC subjects. On multivariate analysis, maximal oxygen consumption (V̇o2max) ( P = 0.009) and maximal exercise output ( P = 0.049) were greater in high PTAC subjects. An exercise-induced decrease in arterial oxygen saturation (98.0 ± 0.4 vs. 96.7 ± 1.4%, P < 0.0001) was not influenced by PTAC status ( P = 0.96). Increased PTAC during exercise is a marker of pulmonary vascular reserve reflected by greater flow, reduced PVR, and enhanced RV function.

Hypoxia-induced intrapulmonary arteriovenous shunting at rest in healthy humans

2010 ◽  
Vol 109 (4) ◽  
pp. 1072-1079 ◽  
Author(s):  
Steven S. Laurie ◽  
Ximeng Yang ◽  
Jonathan E. Elliott ◽  
Kara M. Beasley ◽  
Andrew T. Lovering
Keyword(s):  
Mixture Fraction ◽  
Contrast Echocardiography ◽  
Arterial Oxygen Saturation ◽  
Systolic Pressure ◽  
Arterial Oxygen ◽  
Pulmonary Artery Systolic Pressure ◽  
Arteriovenous Shunting ◽  
Healthy Humans ◽  
Four Levels ◽  
Fraction Of Inspired Oxygen

Intrapulmonary arteriovenous (IPAV) shunting has been shown to occur at rest in some subjects breathing a hypoxic gas mixture [fraction of inspired oxygen (FiO2) = 0.12] for brief periods of time. In the present study we set out to determine if IPAV shunting could be induced at rest in all subjects exposed to hypoxia for 30 min. Twelve subjects (6 women) breathed four levels of hypoxia (FiO2 = 0.16, 0.14, 0.12, and 0.10) for 30 min each in either an ascending or descending order with a 15-min normoxic break between bouts. Saline contrast echocardiography was used to detect IPAV shunt and a shunt score (0–5) was assigned based on contrast in the left ventricle with a shunt score ≥ 2 considered significant. Pulmonary artery systolic pressure (PASP) was determined using Doppler ultrasound. The total number of subjects demonstrating shunt scores ≥ 2 for FiO2 = 0.16, 0.14, 0.12, and 0.10 was 1/12, 7/12, 9/12, and 12/12, respectively. Shunt scores were variable between subjects but significantly greater than normoxia for FiO2 = 0.12 and 0.10. Shunt scores correlated with peripheral measurements of arterial oxygen saturation (SpO2) ( r w = −0.67) and PASP ( r w = 0.44), despite an increased shunt score but no increase in PASP while breathing an FiO2 = 0.12. It is unknown how hypoxia induces the opening of IPAV shunts, but these vessels may be controlled via similar mechanisms as systemic vessels that vasodilate in response to hypoxia. Despite intersubject variability our results indicate significant IPAV shunting occurs at rest in all subjects breathing an FiO2 = 0.10 for 30 min.

EGLN1 variants influence expression and SaO2 levels to associate with high-altitude pulmonary oedema and adaptation

2012 ◽  
Vol 124 (7) ◽  
pp. 479-489 ◽  
Author(s):  
Aastha Mishra ◽  
Ghulam Mohammad ◽  
Tashi Thinlas ◽  
M. A. Qadar Pasha
Keyword(s):  
High Altitude ◽  
Pulmonary Oedema ◽  
Oxygen Sensor ◽  
Arterial Oxygen Saturation ◽  
Systolic Pressure ◽  
Inverse Correlation ◽  
Functional Adaptation ◽  
Arterial Oxygen ◽  
Pulmonary Artery Systolic Pressure ◽  
Association Analyses

EGLN1 [encoding HIF (hypoxia-inducible factor)-prolyl hydroxylase 2] plays a pivotal role in the HIF pathway and has emerged as one of the most intriguing genes with respect to physiology at HA (high altitude). EGLN1, being an actual oxygen sensor, appears to have a potential role in the functional adaptation to the hypobaric hypoxic environment. In the present study, we screened 30 polymorphisms of EGLN1, evaluated its gene expression and performed association analyses. In addition, the role of allelic variants in altering TF (transcription factor)-binding sites and consequently the replacement of TFs at these loci was also investigated. The study was performed in 250 HAPE-p [HAPE (HA pulmonary oedema)-patients], 210 HAPE-f (HAPE-free controls) and 430 HLs (healthy Ladakhi highland natives). The genotypes of seven polymorphisms, rs1538664, rs479200, rs2486729, rs2790879, rs480902, rs2486736 and rs973252, differed significantly between HAPE-p and HAPE-f (P<0.008). The genotypes AA, TT, AA, GG, CC, AA and GG of rs1538664, rs479200, rs2486729, rs2790879, rs480902, rs2486736 and rs973252, prevalent in HAPE-p, were identified as risk genotypes and their counterpart homozygotes, prevalent in HLs, were identified as protective. EGLN1 expression was up-regulated 4.56-fold in HAPE-p (P=0.0084). The risk genotypes, their haplotypes and interacting genotypes were associated with up-regulated EGLN1 expression (P<0.05). Similarly, regression analysis showed that the risk alleles and susceptible haplotypes were associated with decreased SaO2 (arterial oxygen saturation) levels in the three groups. The significant inverse correlation of SaO2 levels with PASP (pulmonary artery systolic pressure) and EGLN1 expression and the association of these polymorphisms with SaO2 levels and EGLN1 expression contributed to uncovering the molecular mechanism underlying hypobaric hypoxic adaptation and maladaptation.

scholarly journals Effects of catheter-directed therapy for pulmonary embolism on pulmonary artery systolic pressure and PaO2/FiO2

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Muzzio ◽  
A Rossini ◽  
D Costa ◽  
L Garcia Iturralde ◽  
C Gonzalez ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Pulmonary Artery ◽  
Systolic Pressure ◽  
Bleeding Risk ◽  
Cardiovascular Death ◽  
Pulmonary Artery Systolic Pressure ◽  
Systemic Thrombolysis ◽  
Funding Sources ◽  
High Bleeding Risk

Abstract Funding Acknowledgements Type of funding sources: None. Background Pulmonary embolism (PE) is the third global cause of cardiovascular death. Treatment of high-risk cases and selected intermediate-risk cases is based on systemic thrombolysis, which can be inconvenient in patients with a contraindications for thrombolysis. Catheter-directed therapies are emerging as an alternative for treatment when there is an increased bleeding risk. Methods One-center retrospective study of patients with high or intermediate-high risk PE with contraindications for systemic thrombolysis. Catheter directed rheolytic thrombectomy or mechanical thrombectomy was performed, assessing its effect on clinical variables, pulmonary artery systolic pressure (PASP), PaO2/FiO2, and the occurrence of complications. Results In 12 patients with PE treated with catheter-directed therapy, we observed a mean increase of the PaO2/FiO2 of 62 mm Hg (p = 0.013), as well mean reduction in the PASP of 13 mm Hg (p &lt; 0.001), as can be observed in the figure. As complications, there was one case of hemoptysis, and two of hemolysis, with an in-hospital mortality of 16.7%. Conclusion Catheter-directed therapy in patients with high or intermediate-high risk PE is a feasible option when there are contraindications for thrombolysis or there is a high bleeding risk. It has been shown to improve surrogate endpoints as PASP and right to left ventricle ratio in other studies, although data on mortality from a randomized trial is lacking. Abstract Figure. Gardner-Altman plots.

scholarly journals Efficacy and safety of hydro-mechanical defragmentation in intermediate- and high-risk pulmonary embolism

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Ayman K. M. Hassan ◽  
Heba Ahmed ◽  
Yousef Ahmed ◽  
Abd-Elazim Abo Elfadl ◽  
Amany Omar
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Oxygen Saturation ◽  
Controlled Trial ◽  
Treatment Options ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
Systemic Thrombolysis ◽  
Recommended Treatment ◽  
Group A

Abstract Background Pulmonary embolism (PE) is the third most common acute cardiovascular syndrome. Percutaneous catheter directed hydro-mechanical defragmentation (HMD) is one of the recommended treatment options for PE in patients with contraindications to thrombolytic therapy or failed systemic thrombolysis (ST). We aimed to identify the safety and outcomes of catheter directed HMD in patients with high-risk PE. This nonrandomized controlled trial enrolled all patients with confirmed diagnoses of high- and intermediate-high-risk PE from October 2019 till January 2021. Fifty patients were included and divided into two groups by the PE response team according to the presence or absence of a contraindication for ST. Group B (ST) consists of 25 patients and group A (HMD) of 25 patients who cannot receive ST. Results The two groups were comparable regarding baseline clinical characteristics with mean age 51 ± 13 years. In group A, systolic blood pressure (BP) and oxygen saturation increased after 24 h (p = 0.002) and 48 h (p < 0.001) compared to pre-HMD procedure. Mean pulmonary artery systolic pressure (PASP) and respiratory rate (RR) decreased after 48 h and at 30 days (p < 0.001) compared to pre-HMD procedure. The increase in systolic BP and oxygen saturation were significantly higher in HMD group compared with ST group after 48 h and at 30 days (p < 0.007). The decrease in PASP and RR was significantly higher in HMD group compared to ST group after 48 h and at 30 days (p < 0.001). Mortality rate at 30 days was 20% in HMD group compared to 32% in ST group. Conclusions Catheter directed HMD for high-risk and intermediate-high-risk PE is safe and effective with acceptable mortality Trial registration Clinical trial ID: NCT04099186.

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