☆ 4.3 Review

Early predictors of clinical deterioration in intermediate-high risk pulmonary embolism: clinical needs, research imperatives, and pathways forward

EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE (2023)

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Article Cardiac & Cardiovascular Systems

Mean arterial pressure predicts 48 h clinical deterioration in intermediate-high risk patients with acute pulmonary embolism

Marco Zuin et al.

Summary: This study assessed the prognostic role of mean arterial pressure (MAP) for 48-hour clinical deterioration in intermediate-high risk pulmonary embolism (PE) patients after admission. The results showed that a MAP of ≤ 81.5 mmHg at admission was the optimal cutoff value for predicting 48-hour clinical deterioration. Age, history of heart failure, simplified Pulmonary Embolism Severity Index, systemic thrombolysis, and a MAP of ≤ 81.5 mmHg at admission were identified as independent risk factors for 48-hour clinical deterioration. The deteriorating group had a significantly higher risk of 30-day mortality compared with the non-deteriorating group.

EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE (2023)

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Review Cardiac & Cardiovascular Systems

Interventional therapies for pulmonary embolism

Felix Goetzinger et al.

Summary: Pulmonary embolism (PE) is a major cause of in-hospital and cardiovascular death. The treatment of PE traditionally involved anticoagulation, thrombolysis, or surgery, but newer percutaneous interventional technologies have emerged for intermediate-high-risk or high-risk PE patients. This review discusses the pathophysiology of PE, assists with patient selection, and evaluates the clinical evidence for interventional, catheter-based approaches for PE treatment.

NATURE REVIEWS CARDIOLOGY (2023)

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Article Hematology

Developing Validated Tools to Identify Pulmonary Embolism in Electronic Databases: Rationale and Design of the PE-EHR plus Study

Behnood Bikdeli et al.

Summary: This study aims to validate the effectiveness of ICD-10 codes and natural language processing tools in identifying patients with pulmonary embolism in electronic health records. Manual chart review will be used as the reference standard, and the discriminatory function of code subgroups will be assessed. This study will improve the reliability of observational studies and randomized trials of patients with pulmonary embolism using electronic databases.

THROMBOSIS AND HAEMOSTASIS (2023)

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Article Hematology

Contemporary Management and Clinical Course of Acute Pulmonary Embolism: The COPE Study

Cecilia Becattini et al.

Summary: The COPE study aimed to assess contemporary clinical management and outcomes in patients with acute symptomatic PE. The majority of patients with PE receive risk stratification and treatment with direct oral anticoagulants. However, in-hospital mortality is still high in intermediate and high-risk patients, calling for further research to reduce mortality.

THROMBOSIS AND HAEMOSTASIS (2023)

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Article Hematology

Contemporary trends in mortality related to high-risk pulmonary embolism in US from 1999 to 2019

Marco Zuin et al.

Summary: The mortality rate related to high-risk PE in the US has increased over the past 21 years, with more pronounced increases in males, Black Americans, and residents of rural areas. Further research is needed to understand the underlying causes of these trends and implement appropriate corrective strategies.

THROMBOSIS RESEARCH (2023)

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Article Cardiac & Cardiovascular Systems

Outcomes in High-Risk Pulmonary Embolism Patients Undergoing FlowTriever Mechanical Thrombectomy or Other Contemporary Therapies: Results From the FLAME Study

Mitchell J. Silver et al.

Summary: Among high-risk PE patients treated with the FlowTriever system, a significantly lower rate of in-hospital adverse clinical outcomes was observed compared to the predefined performance goal, primarily driven by a low all-cause mortality rate of 1.9%.

CIRCULATION-CARDIOVASCULAR INTERVENTIONS (2023)

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Review Cardiac & Cardiovascular Systems

Time-based reperfusion in haemodynamically unstable pulmonary embolism patients: does early reperfusion therapy improve survival?

Marco Zuin et al.

Summary: High-risk pulmonary embolism (PE) is associated with significant morbidity and mortality. Systemic thrombolysis remains the most evidenced-based treatment for haemodynamically unstable PE, but it is underused in clinical practice. The optimal timing for reperfusion therapy in high-risk PE patients has not been defined. This article reviews the evidence and suggests potential strategies to explore the benefit of earlier administration of reperfusion in haemodynamically unstable PE patients.

EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE (2023)

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Article Hematology

Reduced-Dose Intravenous Thrombolysis for Acute Intermediate-High-risk Pulmonary Embolism: Rationale and Design of the Pulmonary Embolism International THrOmbolysis (PEITHO)-3 trial

Olivier Sanchez et al.

Summary: The PEITHO-3 study aims to compare the efficacy and safety of reduced-dose thrombolysis with standard anticoagulation in patients with intermediate-high-risk PE. The primary outcome is a composite of all-cause death, hemodynamic decompensation, or PE recurrence within 30 days, with key secondary outcomes including bleeding events. The study plans to enroll 650 patients and may impact future guideline recommendations for acute PE treatment.

THROMBOSIS AND HAEMOSTASIS (2022)

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Article Cardiac & Cardiovascular Systems

Ultrasound-facilitated, catheter-directed thrombolysis vs anticoagulation alone for acute intermediate-high-risk pulmonary embolism: Rationale and design of the HI-PEITHO study

Frederikus A. Klok et al.

Summary: This study aims to evaluate the clinical benefits of catheter-directed treatment and determine the first-line treatment for pulmonary embolism patients.

AMERICAN HEART JOURNAL (2022)

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Article Cardiac & Cardiovascular Systems

Pharmacomechanical Catheter-Directed Thrombolysis With the Bashir Endovascular Catheter for Acute Pulmonary Embolism The RESCUE Study

Riyaz Bashir et al.

Summary: This study evaluated the efficacy and safety of a pharmacomechanical catheter-directed thrombolysis (CDT) device called the Bashir endovascular catheter in patients with intermediate-risk acute pulmonary embolism (PE). The results showed a significant reduction in the RV/LV diameter ratio, PA obstruction, and low rates of adverse events or major bleeding.

JACC-CARDIOVASCULAR INTERVENTIONS (2022)

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Article Cardiac & Cardiovascular Systems

Percutaneous treatment options for acute pulmonary embolism: a clinical consensus statement by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function and the European Association of Percutaneous Cardiovascular Interventions

Piotr Pruszczyk et al.

Summary: There is a growing interest in catheter-directed therapy (CDT) for acute pulmonary embolism (PE). This paper aims to describe the available CDT approaches and standardize patient selection, procedure timing and technique, as well as anticoagulation regimens. The paper also discusses various clinical scenarios for evaluating the efficacy of thrombolysis and anticoagulation.

EUROINTERVENTION (2022)

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Article Critical Care Medicine

Intermediate-risk pulmonary embolism: echocardiography predictors of clinical deterioration

Anthony J. Weekes et al.

Summary: In patients with intermediate-risk pulmonary embolism (PE), baseline right ventricle (RV), RV/LV ratio, and RV systolic function measurements are significantly different between those who experience subsequent clinical deterioration and those who do not.

CRITICAL CARE (2022)

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Article Medicine, General & Internal

Venous lactate improves the prediction of in-hospital adverse outcomes in normotensive pulmonary embolism

Matthias Ebner et al.

Summary: Arterial lactate is an established risk marker in PE patients, but venous lactate can also be an indicator of adverse outcomes and mortality. An optimized cut-off value of 3.3 mmol/L for venous lactate was found to be more predictive than the established cut-off for arterial lactate and the upper limit of normal for venous lactate.

EUROPEAN JOURNAL OF INTERNAL MEDICINE (2021)

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Letter Cardiac & Cardiovascular Systems

Efficacy and Safety of Low-Dose Systemic Fibrinolytic Therapy for Acute Submassive Pulmonary Embolism

Ahmet Guner et al.

JACC-CARDIOVASCULAR INTERVENTIONS (2021)

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Review Anesthesiology

What are the echocardiographic findings of acute right ventricular strain that suggest pulmonary embolism?

Stephen Alerhand et al.

Summary: This manuscript reviews ten echocardiographic findings of right ventricular strain that may suggest a diagnosis of PE. Physicians must recognize and understand these findings and associated pathophysiology in order to expedite the diagnosis and treatment of PE.

ANAESTHESIA CRITICAL CARE & PAIN MEDICINE (2021)

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Article Medicine, General & Internal

Low-dose thrombolysis for submassive pulmonary embolism

Emine Serap Yilmaz et al.

Summary: This study aimed to evaluate the role of half-dose rt-PA in preventing death/hemodynamic decompensation in submassive (intermediate-risk) PE without increasing the risk of bleeding. The results showed that treatment with half-dose rt-PA significantly reduced the risk of death or hemodynamic decompensation in submassive PE patients within the first 7 and 30 days.

JOURNAL OF INVESTIGATIVE MEDICINE (2021)

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Article Cardiac & Cardiovascular Systems

2019 ESC Guidelines for the dignosis and management of acute pulmonary embolism development Toed in colaboration with the European Respiratory Society (ERS)

Stavros Konstantinides et al.

EUROPEAN HEART JOURNAL (2020)

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Pulmonary Embolism and Unfractionated Heparin: Time to End the Roller Coaster Ride

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ACADEMIC EMERGENCY MEDICINE (2020)

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Analysis of Partial Thromboplastin Times in Patients With Pulmonary Embolism During the First 48 Hours of Anticoagulation With Unfractionated Heparin

Christiana K. Prucnal et al.

ACADEMIC EMERGENCY MEDICINE (2020)

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Structure, mechanical properties, and modeling of cyclically compressed pulmonary emboli

Irina N. Chernysh et al.

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Cost-effectiveness microsimulation of catheter-directed thrombolysis in submassive pulmonary embolism using a right ventricular function model

Stefanie E. Mason et al.

JOURNAL OF THROMBOSIS AND THROMBOLYSIS (2020)

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Elevated Lactate Levels in Acute Pulmonary Embolism Are Associated with Prothrombotic Fibrin Clot Properties: Contribution of NETs Formation

Michal Zabczyk et al.

JOURNAL OF CLINICAL MEDICINE (2020)

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Article Medicine, General & Internal

Definition of tachycardia for risk stratification of pulmonary embolism

Lukas Hobohm et al.

EUROPEAN JOURNAL OF INTERNAL MEDICINE (2020)

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Article Cardiac & Cardiovascular Systems

Advanced Management of Intermediate- and High-Risk Pulmonary Embolism JACC Focus Seminar

Gregory Piazza

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2020)

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Article Cardiac & Cardiovascular Systems

Assessing the Nationwide Impact of a Registry-Based Randomized Clinical Trial on Cardiovascular Practice The TASTE Trial in Perspective

Sergio Buccheri et al.

CIRCULATION-CARDIOVASCULAR INTERVENTIONS (2019)

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Article Critical Care Medicine

Half-Dose Versus Full-Dose Alteplase for Treatment of Pulmonary Embolism

Tyree H. Kiser et al.

CRITICAL CARE MEDICINE (2018)

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Letter Respiratory System

Improved identification of thrombolysis candidates amongst intermediate-risk pulmonary embolism patients: implications for future trials

Stefano Barco et al.

EUROPEAN RESPIRATORY JOURNAL (2018)

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A Randomized Trial of the Optimum Duration of Acoustic Pulse Thrombolysis Procedure in Acute Intermediate-Risk Pulmonary Embolism The OPTALYSE PE Trial

Victor F. Tapson et al.

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Neutrophil extracellular traps form predominantly during the organizing stage of human venous thromboembolism development

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Prognostic Value of Plasma Lactate Levels Among Patients With Acute Pulmonary Embolism: The Thrombo-Embolism Lactate Outcome Study

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Simplification of the Pulmonary Embolism Severity Index for Prognostication in Patients With Acute Symptomatic Pulmonary Embolism

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ARCHIVES OF INTERNAL MEDICINE (2010)

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Prognostic value of troponins in acute pulmonary embolism - A meta-analysis

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Right ventricular strain in pulmonary embolism by Doppler tissue echocardiography

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Cardiac troponin T monitoring identifies high-risk group of normotensive patients with acute pulmonary embolism

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