RESUMO
Objective:To analyze the clinical characteristics and risk stratification of 182 patients with acute pulmonary embolism (APE), and to investigate the correlation of neutrophil (N)/lymphocyte (L) ratio (NLR) and risk stratification/prognosis.Methods:The clinical data of 182 APE patients admitted to Peking University People’s Hospital from January 2015 to March 2021 were retrospectively collected, including age, sex, symptoms and signs, blood pressure, blood gas analysis, blood routine parameters, cardiac biomarkers, coagulation parameters, and right ventricular imaging parameters. The patients were divided into groups according to the risk stratification at admission and prognosis in hospital. χ2 test, t test or nonparametric test were used to analyze the differences in clinical characteristics, blood routine parameters, blood gas analysis, coagulation parameters and other parameters between the groups. Multivariate logistic regression analysis was used to study the independent risk factors for the prognosis of APE. Results:Among the 182 patients, 79 were male and 103 were female, 23 were in the high-risk group, 51 were in the intermediate-high-risk group, 46 were in the intermediate-low risk group, and 62 were in the low-risk group. There were 27 deaths and 155 survivors. The respiratory rate of the high/intermediate-high-risk group was significantly higher than that of the low/intermediate-low-risk group. Compared with the other three groups, pH, oxygen partial pressure (PO 2) and blood oxygen saturation (SO 2) in the high-risk group were significantly lower ( both P<0.05). There were statistically significant differences in WBC, N, and NLR levels between the high/intermediate-high-risk group and low/intermediate-low-risk group ( both P<0.05). However there were no significant differences in PLT, PLT/MPV, PLT/PDW, and coagulation related parameters PT, FIB, APTT and D-D between groups (all P > 0.05). MPV and PDW were only significantly different between the low-risk group, intermediate-low-risk group and high-risk group ( both P<0.05). Multivariate logistic regression analysis showed that NLR ( OR=1.179,95% CI:1.029-1.410, P=0.039) and PH ( OR=1.156,95% CI:1.031-1.522, P=0.041) were independent predictors of in-hospital mortality. The ROC curve was used to analyze the predictive value of NLR for in-hospital mortality. When the cutoff value of NLR was 8.38, the AUC of NLR was 0.824 (95% CI: 0.829-0.913), the corresponding sensitivity was 0.831, and the specificity was 0.887. Conclusions:NLR is correlated with risk stratification and prognosis of APE, and is an independent risk factor for poor prognosis.
RESUMO
ObjectiveTo explore the application value of CT pulmonary angiography (CTPA) in assessing the severity of acute pulmonary embolism (APE) and right heart function in rehabilitation patients. MethodsFrom January, 2013 to January, 2020, 133 inpatients (94 positive and 39 negative) who underwent CTPA examination in Beijing Bo'ai Hospital were involved. Positive patients were further divided into mild, moderate and severe groups based on the pulmonary artery obstruction index (PAOI). The clinical parameters and right heart function indicators were compared. Spearman correlation analysis was used to analyze the correlation between PAOI, and clinical parameters and right heart function indicators, and Logistic regression analysis was used to predict the risk factors of APE. ResultsThere was significant difference in lower extremity venous thrombosis, D-dimer, oxygen partial pressure, PAOI and left process of interventricular septum among four groups (H ≥ 12.350, P < 0.01). PAOI was moderately positively correlated with D-dimer (r = 0.443, P < 0.001) and left process of interventricular septum (r = 0.520, P < 0.001), and was weakly positively correlated with lower extremity venous thrombosis (r = 0.399, P < 0.001), left pulmonary artery diameter (r = 0.213, P = 0.014) and inferior vena cava regurgitation (r = 0.229, P = 0.008). Lower extremity venous thrombosis (OR = 7.708, P < 0.001) and left process of interventricular septum (OR = 3.641, P = 0.008) were independent risk factors for the onset of APE. The combination of the two indicators was effective for diagnosis of APE, and AUC was 0.795 (95% CI 0.715 to 0.874). ConclusionCTPA may be applied to evaluate the severity of APE and right heart function in rehabilitation patients.
RESUMO
Objective To analyze the pulmonary perfusion defect index (PPDI) of dual-energy computed tomography (CT) and pulmonary artery obstruction index (PAOI) of conventional CT angiography, and to investigate the clinical application value of dual-energy CT perfusion imaging in the examination of patients with acute pulmonary embolism. Methods A retrospective study was conducted on 21 patients diagnosed with acute pulmonary embolism in Weifang People's Hospital from January 1, 2022 to December 31, 2022. PPDI, PAOI, and maximum plasma D-dimer concentration (mg/L) were calculated. According to the 2019 ESC Guidelines, the patients were divided into low-risk group (n = 8) and medium-risk group (n = 12). The Mann-Whitney U test was used for between-group comparisons. The Spearman’s rank correlation coefficient was used to analyze the correlations between PAOI, PPDI, and plasma D-dimer concentration. Results The PPDI, PAOI, and D-dimer values in the low-risk group were 3.33 (2.09, 4.58), 5.00 (3.13, 5.00), and 0.67 (0.52, 0.79), respectively. The PPDI, PAOI, and D-dimer values in the middle-risk group were 8.34 (5.42, 12.50), 12.50 (8.13, 15.00), and 1.18 (0.86, 2.87), respectively. The Z-values of comparison between the two groups were −3.092, −3.650, and −3.318, respectively (all P < 0.05). There were significant differences in PPDI, PAOI, and D-dimer between the low-risk and middle-risk groups (P < 0.05). Positive correlations were observed between PPDI and PAOI, between PPDI and D-dimer, and between PAOI and D-dimer (rs = 0.869, 0.918, 0.909, all P < 0.05). Conclusion Both PPDI and PAOI can be used for the clinical examination of patients with acute pulmonary embolism and evaluation of the severity of the disease. Compared with conventional CT, dual-energy CT perfusion imaging is more efficient in the diagnosis of acute pulmonary embolism, and facilitates accurate clinical treatment.
RESUMO
Abstract Direct oral anticoagulants (DOACs) have become the standard of care for acute and long-term therapy for venous thromboembolism (VTE) due to their efficacy and safety profiles. The 2021 International Society on Thrombosis and Haemostasis guidelines recommend using standard DOAC dosages in patients with BMI >40 kg/m2 or weight >120 kg. Use of DOACs remains uncertain in morbidly obese patients with VTE, including acute PE. A morbidly obese woman in her 30s who presented with acute worsening of dyspnea was diagnosed with acute intermediate-high risk acute pulmonary embolism and concomitant proximal deep vein thrombosis, constituting a clinically challenging scenario for treating her with rivaroxaban. Standard doses of rivaroxaban for acute and extended phase treatment of venous thromboembolism in individuals with morbid obesity at BMI>70 kg/m2 may be effective, and safe.
Resumo Devido à sua eficácia e aos seus perfis de segurança, os anticoagulantes orais diretos (DOACs) tornaram-se o padrão de cuidado para a terapia aguda e de longo prazo de tromboembolismo venoso (TEV). As diretrizes da Sociedade Internacional de Trombose e Hemostasia de 2021 recomendam o uso de dosagens padrão de DOACs em pacientes com índice de massa corporal (IMC) > 40 kg/m2 ou peso > 120 kg. O uso de DOACs em pacientes com obesidade mórbida e TEV, incluindo embolia pulmonar aguda, ainda não foi esclarecido. Uma mulher com obesidade mórbida na faixa dos 30 anos que apresentou piora aguda da dispneia foi diagnosticada com embolia pulmonar aguda de risco intermediário-alto e trombose venosa profunda proximal concomitante, com o cenário clínico desafiador de tratá-la com rivaroxabana. Doses padrão de rivaroxabana para tratamento e recorrência de tromboembolismo venoso em indivíduos com obesidade mórbida e IMC > 70 kg/m2 podem ser eficazes e seguras.
RESUMO
Background: Acute right ventricular dysfunction (RVD) is a leading cause of death in the setting of acute pulmonary embolism (PE). Therefore, several studies investigated the predisposing factors of RVD. However, at present, little is known about the clinical predictors of RVD in the patients presented with acute PE. Objective: To assess the association of CHA2DS2-VASc Score with the PE severity, RVD and the in-hospital mortality in patients presented with acute PE. Methods: This study was conducted on 50 patients admitted with acute PE at Tanta University Hospitals. We studied the association of different variables including demographic data, common risk factors, clinical presentation, management and the in-hospital mortality with the PE clinical subgroups (massive, sub-massive and non-massive) based on the severity of clinical presentation and also the association of these variables with the thromboembolic risk (high, moderate and low) based on the CHA2DS2-VASc scores. The independent predictors of the RVD were then investigated by the univariate and multivariate regression analyses. Results: The massive PE presentation was associated with higher CHA2DS2-VASc scores (P value = 0.02). Also, the incidence of RVD was higher among the high risk group of patients (CHA2DS2-VASc scores ?3) with P value = 0.009. TAPSE, MPI, FAC, and E`/A` ratio were found to be more significant in the high risk group (P value = 0.032, 0.002, 0.007 and 0.001), respectively. The independent predictors of RVD were demonstrated to be tachycardia, lower systolic blood pressure and CHA2DS2-VASc score (P value = 0.022, 0.007, 0.021), respectively. The CHA2DS2-VASc score predicted the presence of RVD with 66.7 % sensitivity and 78.6% specificity as demonstrated by the receiver operating characteristic (ROC) analysis, with area under the curve (AUC) of 0.776 (CI 0.636-0.882, P value < 0.001). This study demonstrated no statistically significant difference between the different risk groups regarding the in-hospital mortality. Conclusion: Being independent of other factors, the CHA2DS2-VASc score can be used as a new, simple, and reliable tool to predict the development of RVD in patients with acute PE.
RESUMO
Neuroleptic malignant syndrome (NMS)is a life-threatening complication seen in psychiatric patients exposed to antipsychotic medications. NMSis associated with medication with dopamine antagonist action. The typical tetrad of symptoms of NMS includes fever, muscle rigidity, altered mental status and autonomic dysfunction. Acute pulmonary embolism is one of the major complications seen in patients diagnosed with neuroleptic malignant symptoms. Here we present a case report of a 64 years old female with a history of psychiatric illness, presented with fever, rigidity andaltered mental status and diagnosed to haveNMS. Later her condition was complicated by pulmonary embolism. She was treated with bromocriptine and heparin infusion and improved symptomatically.
RESUMO
Objective:To explore the clinical value of arterial partial pressure of carbon dioxide (PaCO 2) combined with Wells score in predicting acute pulmonary embolism (PE). Methods:Patients with suspected acute PE admitted to Emergency Department of Beijing Chaoyang Hospital, Capital Medical University from January 1, 2016 to August 31, 2021 were screened. Patients with positive computed tomography pulmonary angiography (CTPA) results were classified as the PE group, and those with negative CTPA results were classified as the non-PE group. Demographic characteristics, symptoms, vital signs, underlying diseases, risk factors for venous thrombosis, arterial blood gas analysis and Wells scores were statistically analyzed and compared between the two groups, and the clinical efficacy of PaCO 2 combined with Wells score in predicting acute PE was evaluated. Results:A total of 1 869 patients with suspected acute PE were screened, and 1 492 patients were finally selected. There were 537 cases in the PE group and 955 cases in the non-PE group. The frequency of chest pain, dyspnea, unilateral lower limb edema, history of PE or deep venous thrombosis, history of surgery or immobilization within 3 months, history of fracture within 3 months, active malignant tumor, elevated Wells score and reduced PaCO 2 in the PE group was significantly higher than that in the non-PE group (all P< 0.05). The area under receiver operating characteristic (ROC) curve (AUC) of Wells score was 0.784 (95% CI: 0.758-0.810), and the sensitivity and specificity of predicting acute pulmonary embolism were 61.64% and 88.48%, respectively. The AUC of reduced PaCO 2 was 0.679 (95% CI: 0.651-0.707), and the sensitivity and specificity of predicting acute pulmonary embolism were 79.89% and 55.92%, respectively. The AUC of reduced PaCO 2 combined with Wells score was 0.837 (95% CI: 0.816-0.858), and the sensitivity and specificity of predicting acute pulmonary embolism were 74.12% and 77.07%, respectively. The AUC of reduced PaCO 2 combined with Wells score was significantly greater than the AUC of Wells score ( P<0.001) and the AUC of reduced PaCO 2 ( P<0.001). Conclusions:The efficacy of PaCO 2 reduction combined with Wells score in predicting acute PE was superior to that of either of them alone. This was a beneficial supplement to the screening of patients with acute PE, and would also help reduce the abuse of CTPA in the emergency department.
RESUMO
Objective:To analyze the effect of elevated pulmonary artery pressure measured by echocardiography on clinical characteristics and adverse events in patients with acute pulmonary embolism.Methods:Retrospective analysis hospitalized patients with acute pulmonary embolism diagnosed in Beijing Anzhen Hospital Affiliated to Capital Medical University from January 1, 2018 to December 31, 2020 were divided into elevated pulmonary artery pressure group and control group according to pulmonary artery pressure measured by echocardiography. The differences between the two groups in admission baseline data, admission basic situation, admission hematology examination, admission imaging examination, in-hospital medication and in-hospital adverse events were compared.Results:A total of 568 patients with acute pulmonary embolism were included, including 178 in the elevated pulmonary artery pressure group and 390 in the control group. The data analysis of the two groups showed that the proportion of height, weight, body mass index, smoking history, coronary heart disease history, stroke history, diabetes history, chronic heart failure history, chronic obstructive pulmonary disease history and chronic renal insufficiency history in the group with elevated pulmonary artery pressure was significantly higher than that in the control group. The proportion of fracture in the group with elevated pulmonary artery pressure was significantly lower than that in the control group, and the proportion of tumor and heart rate were significantly higher than those in the control group. The hemoglobin, international standardized ratio, D-dimer, PaO 2, SaO 2, etc. of patients with elevated pulmonary artery pressure were significantly lower than those of the control group, and TnI, B-type natriuretic peptide, etc. were significantly higher than those of the control group. The left ventricular ejection fraction of patients with elevated pulmonary artery pressure was significantly lower than those of the control group, and the left ventricular end diastolic diameter, the proportion of mitral regurgitation, the proportion of tricuspid regurgitation, and the proportion of pulmonary artery embolism were significantly higher than those of the control group. The use proportion of rivaroxaban in patients with elevated pulmonary artery pressure was significantly lower than that in the control group, and the use proportion of aspirin and warfarin was significantly higher than that in the control group. The incidence of all-cause death, acute heart failure and in-hospital hemorrhage in the group with elevated pulmonary artery pressure was significantly higher than that in the control group. There was no significant difference in other indexes between the two groups. Conclusions:There are some differences in clinical characteristics and prognosis between patients with acute pulmonary embolism complicated with elevated pulmonary artery pressure and patients with normal pulmonary artery pressure. The increase of pulmonary artery pressure may increase the risk of all-cause death, acute heart failure and nosocomial bleeding to a certain extent.
RESUMO
@#BACKGROUND: Acute pulmonary embolism (APE) with cardiac arrest (CA) is characterized by high mortality in emergency due to pulmonary arterial hypertension (PAH). This study aims to determine whether early pulmonary artery remodeling occurs in PAH caused by massive APE with CA and the protective effects of increasing angiotensin-converting enzyme (ACE) 2-angiotensin (Ang) (1-7)-Mas receptor axis and ACE-Ang II-Ang II type 1 receptor (AT1) axis (ACE2/ACE axes) ratio on pulmonary artery lesion after return of spontaneous circulation (ROSC). METHODS: To establish a porcine massive APE with CA model, autologous thrombus was injected into the external jugular vein until mean arterial pressure dropped below 30 mmHg (1 mmHg=0.133 kPa). Cardiopulmonary resuscitation and thrombolysis were delivered to regain spontaneous circulation. Pigs were divided into four groups of five pigs each: control group, APE-CA group, ROSC-saline group, and ROSC-captopril group, to examine the endothelial pathological changes and expression of ACE2/ACE axes in pulmonary artery with or without captopril. RESULTS: Histological analysis of samples from the APE-CA and ROSC-saline groups showed that pulmonary arterioles were almost completely occluded by accumulated endothelial cells. Western blotting analysis revealed a decrease in the pulmonary arterial ACE2/ACE axes ratio and increases in angiopoietin-2/angiopoietin-1 ratio and expression of vascular endothelial growth factor (VEGF) in the APE-CA group compared with the control group. Captopril significantly suppressed the activation of angiopoietin-2/angiopoietin-1 and VEGF in plexiform lesions formed by proliferative endothelial cells after ROSC. Captopril also alleviated endothelial cell apoptosis by increasing the B-cell lymphoma-2 (Bcl-2)/Bcl-2-associated X (Bax) ratio and decreasing cleaved caspase-3 expression. CONCLUSION: Increasing the ACE2/ACE axes ratio may ameliorate pulmonary arterial remodeling by inhibiting the apoptosis and proliferation of endothelial cells after ROSC induced by APE.
RESUMO
Objective:To evaluate the feasibility of a new ultrasonic parameter to assess right ventricular-pulmonary artery (RV-PA) coupling in patients with acute pulmonary embolism (APE).Methods:A retrospective analysis was performed in 140 patients with APE diagnosed by computed tomography pulmonary angiography (CTPA) in the Second Affiliated Hospital of Harbin Medical University from August 2017 to June 2020. According to the tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure (TAPSE/PASP) ratio cutoff value 0.40 mm/mmHg reported by the European Society of Cardiology in 2020, the patients were divided into the coupling group ( n=99) and the uncoupling group ( n=41). The conventional ultrasonic parameters of the 2 groups were measured, and then several ultrasonic parameter ratios were obtained. The new ultrasonic parameter, which can replace the TAPSE/PASP ratio, was screened out by Spearman correlation analysis, and ROC curve was plotted to calculate the diagnostic efficacy of this parameter. Results:①Compared with the coupling group, patients in the uncoupling group were older and more likely to be accompanied by dyspnea and venous thrombosis in the lower extremities (all P<0.05), but there was no significant difference in other general data(all P>0.05); ②Compared with the coupling group, tricuspid regurgitation velocity (TRV), tricuspid regurgitation pressure gradient(TRPG), PASP, right ventricle end-diastolic transverse diameter(RVTD), inferior vena cava(IVC) diameter and the ratio of early diastolic tricuspid inflow to tricuspid lateral annular velocity(E/e′), in the uncoupling group increased significantly (all P<0.05), and TAPSE, peak systolic velocity of tricuspid annulus(s′), TAPSE/PASP ratio, TAPSE/TRPG ratio, TAPSE/RVTD ratio and s′/TRPG ratio decreased significantly (all P<0.05); ③The TAPSE/TRPG ratio was highly correlated with TAPSE/PASP ratio ( rs=0.970, P<0.001); The TAPSE/TRPG ratio was still highly correlated with TAPSE/PASP ratio in the uncoupling and coupling groups ( rs=0.966, 0.922; all P<0.001). ④ROC analysis showed that the area under curve for TAPSE/TRPG in diagnosing RV-PA coupling was 0.992. At the cutoff of TAPSE/TRPG <0.625 mm/mmHg for indicating RV-PA coupling, the sensitivity and specificity were 97.6% and 92.9%, respectively. Conclusions:TAPSE/TRPG ratio can be used as a new ultrasonic parameter to reflect RV-PA coupling, which is helpful for clinical identification of APE patients with high risk and poor prognosis.
RESUMO
Objective:To discuss the risk factors, treatment process and prevention strategy of the cases of acute pulmonary embolism after cerebral hemorrhage, so as to improve the attention and level of the disease.Methods:The data of a patient with cerebral hemorrhage and acute pulmonary embolism treated in Lianyungang First People's Hospital were analyzed retrospectively, and the literature related to intracerebral hemorrhage complicated with acute pulmonary embolism was reviewed.Results:One week after intracerebral hemorrhage, the patient was diagnosed with acute pulmonary embolism and given anticoagulant treatment with low molecular weight heparin. The condition was alleviated without aggravating intracerebral hemorrhage. Lying in bed after intracerebral hemorrhage, limb braking, use of dehydration, diuresis, hemostasis and other drugs were the high-risk factors of pulmonary embolism.Venous thromboembolism can be prevented clinically by physical methods and drugs.Conclusions:Venous thromboembolism is easy to occur after intracerebral hemorrhage. Clinically, the incidence can be reduced by pneumatic therapy or anticoagulant drugs. In treatment, it is necessary to weigh the risk of death of pulmonary embolism and rebleeding. After comprehensive evaluation, we can formulate an individualized treatment plan. It may be safe and effective to use low molecular weight heparin to treat pulmonary embolism after the intracerebral hemorrhage hematoma is stable.
RESUMO
OBJECTIVE：To explore the mec hanism of baicalein plat elet aggregation inhibitiory effect and lung tissue protective effect of baicalein in model rats with acute pulmonary embolism. METHODS ：Totally 36 rats were randomly divided into normal control group （n＝6）and modeling group （n＝30）. The acute pulmonary embolism model was established by autologous thrombus replication in modeling group ，and the sham operation of rats in normal control group was carried out. After modeling ， 30 model rats were randomly divided into model control group ，positive drug group （low molecular weight heparin calcium 0.01 mL/kg，subcutaneous injection ），baicalein low-dose ，middle-dose and high-dose groups （25，50，100 mg/kg，intraperitoneal injection），with 6 rats in each group. Normal control group and model control group were intraperitoneally injected constant volume of normal saline ；administration groups were given relevant medicine ，once a day ，for consecutive 7 d. After medication ， platelet aggregation rates of rats after activated with adenosine diphosphate （ADP） and arachidonic acid （AA） and platelet activation index （RPI）were detected ；lung histopathology was observed by HE staining ；serum platelet activation markers granule membrane（CD62P）and lysosomal membrane glycoprotein （CD63），growth differentiation factor- 15（GDF-15）and N-terminal B-type natriuretic peptide （NT-proBNP）were measured by ELISA. The mRNA expression levels of Notch 2，Notch3 and Notch signaling ligand PLL 1，JAG2 were detected by RT-PCR method. The protein expression levels of Notch 2，Notch3，DLL1 and JAG2 in lung tissue were detected by immunohistochemistry and Western blotting assay. RESULTS ：Compared with normal control group，plasma ADP-activated platelet aggregation rate ，AA-activated platelet aggregation rate ，RPI，serum levels of CD 62P， CD63，GDF-15 and NT-proBNP were increased significantly （P＜0.05）. The lung tissue of rats was in a state of severe inflammatory infiltration. mRNA and protein expression levels of Notch 2，Notch3，DLL1 and JAG 2 in lung tissue decreased significantly（P＜0.05）. Compared with model control group ，changes of above indexes of rats were improved significantly in baicalein groups （P＜0.05）. CONCLUSIONS ：Baicalein can reduce platelet aggregation and improve the pathological state of lung tissue in rats with acute pulmonary embolism. Its mechanism 0270） may be related to activating Notch signal pathway.
RESUMO
Pulmonary embolism (PE) may be potentially fatal if not diagnosed and treated in time. Although specific electrocardiogram (ECG) findings often suggest the diagnosis of PE, occasionally, the ECG may mimic that of an acute coronary syndrome (ACS). We report an interesting case of a 45-year-old female presenting with sudden onset chest pain and shortness of breath with widespread ST depression in anterior precordial leads. Although initially treated and referred as a case of ACS, careful analysis of the ECG and subsequent echocardiography and computed tomography imaging confirmed the diagnosis of PE. Intensivists and cardiologists need to be aware that diagnostic dilemma between PE and ACS is not uncommon due to such “ischemic-looking” ECG as well as elevated troponin levels in both conditions. The use of multimodality imaging techniques is helpful in arriving at the correct diagnosis.
RESUMO
Objective To explore the value of the morphological quantitative indexes and the number of emboli in predicting heart function in patients with acute pulmonary embolism (APE)based on computer-aided diagnosis (CAD)technique.Methods One-hundred and forty-eight APE patients confirmed by CT pulmonary angiography (CTPA)in our hospital.Total number of emboli (N)and three morphological quantitative indexes,including total volume of emboli (V),total length (L)and total maximum cross-section embolism proportion (P)were obtained by CAD.The maximal short axis and area of left and right ventricular (LVd,RVd,LVS,RVS)were measured by hand on axial image to calculate the ratio of maximal short axis of right and left ventricular (RVd/LVd)and ratio of maximal area of right and left ventricular (RVS/LVS).The correlation of the above indexes was analyzed by the Pearson correlation of SPSS 22.0.Results The ranking of the correlation between CAD indexes and the heart function was in the order of V,L,P and N.The correlation between CAD indexes and the right heart function was greater than that of the left heart.The V had the strongest correlation with RVd (r=0.544,P=0.000),RVS (r=0.515,P=0.000),RVd/LVd (r=0.595,P=0.000)and RVS/LVS (r=0.579,P=0.000),respectively.While other the CAD indexes had lower correlation with the heart function (|r|:0.167-0.476,P<0.05),and there was no correlation between the N and the left heart function.Conclusion In embolic morphology and quantitative indexes,the V is the best quantitative index to reflect the change of right heart function in APE,which can reflect dys-function of right heart and severity of pulmonary embolism dis-ease in the APE embolism patient.
RESUMO
Objective To observe the myocardial apoptosis and the molecular mechanism of captopril inhibiting myocardial apoptosis on cardiac arrest (CA) after resuscitation in a porcine acute pulmonary embolism (APE) model. Methods In this study, 29 inbred Beijing Landrace wererandomly (random number)divided into four groups (n=5, each group): control, APE-CA, restoration of spontaneous circulation (ROSC)-captopril, and ROSC-saline. The model of CA and ROSC was induced by APE through injection of thrombus followed by cardiopulmonary resuscitation and thrombolytic therapy (urokinase, 15000 U/kg, iv). Ten of 19 pigs with CA recovered to spontaneous circulation were divided randomly into the ROSC-captopril and ROSC-saline groups. Pigs in the ROSC-captopril group were treated with captopril (22.22 mg/kg) via porcine femoral vein at 30 min after ROSC. Pigs in the ROSC-saline group were treated with equal normal saline at 30 min after ROSC. The myocardial tissues were evaluated at 6 h after ROSC. Western blot was used to evaluate the protein levels of Bax, Bcl-2, Caspase-3, phosphorylated (p)-Src and phosphorylated extracellular regulated protein kinase (p-ERK1/2). Immunohistochemistry was used to evaluate the protein expression of p-Src and p-ERK1/2. Enzyme-linked immunosorbent assay was used to detect myocardial Na+-K+-ATPase levels. Statistical analysis was performed using one-way analysis of variance and pearson correlation test. Results Compared with the control group, the protein expression of Bax (0.25±0.01, 0.53±0.01, 0.37±0.05, F=14.16, P<0.05) and Caspase-3 (0.24±0.01, 0.33±0.01, 0.34±0.06, F=7.32, P<0.05) in the APE-CA and ROSC- saline group were increased significantly, and the Bcl-2 expression was significantly decreased (0.56±0.02, 0.19±0.01, 0.37±0.10, F=6.68, P<0.05). Captopril reduced the protein levels of Caspase-3 and Bax, while stimulated the Bcl-2 expression (all P<0.05). Compared with the control group, the protein expression of p-Src and p-ERK1/2 were higher and the Na+-K+-ATPase level was decreased on CA and ROSC induced by APE (all P<0.05). Compared with the APE-CA group, the p-Src expression in the ROSC-captopril group (0.46±0.01 vs. 0.35±0.06, P<0.05) was decreased significantly. Captopril inhibited the activation of p-ERK1/2 than saline group (0.41±0.10 vs. 0.26±0.07, P<0.05), but has no effect on the Na+-K+-ATPase level. The protein expression of p-Src and p-ERK1/2 were positively correlated with the Bax, and negatively correlated with the Bcl-2 respectively. The myocardial Na+-K+-ATPase level negatively correlated with Caspase-3 protein expression. Conclusions The molecular mechanism of cardiomyocyte apoptosis on CA and ROSC induced by APE might be related to decreased Na+-K+-ATPase level and activation of p-Src and p-ERK1/2. The cardiomyocyte apoptosis were inhibited by captopril through reducing the expression of p-Src and p-ERK1/2 in myocardium.
RESUMO
Objective To observe the hemodynamic change during cardiac arrest (CA) and after restoration of spontaneous circulation (ROSC) in a porcine acute pulmonary embolism model. Methods A total of 14 inbred Beijing Landraces were used to estalish the model of CA and ROSC induced by acute pulmonary embolism through injection of thrombus followed by cardiopulmonary resuscitation and thrombolytic therapy (urokinase, 15000 U/kg, iv). Five resuscitated pigs restored spontaneous circulation. Hemodynamic changes were determined at baseline, CA, ROSC, and 0.5, 1, 1.5, 2, 2.5, 4, and 6 h after ROSC. Results Compared with the baseline, mean arterial pressure was decreased significantly, mean pulmonary arterial pressure and right ventricular pressure were increased significantly, and the heart rate had no change during CA induced by acute pulmonary embolism. The mean arterial pressure restored normal level gradually after ROSC, but was decreased at 4 h after ROSC compared with the baseline (P<0.05). The heart rate was faster at ROSC and 0.5-2 h after ROSC than the baseline (P<0.05). The mean pulmonary arterial pressure restored the baseline level after ROSC; The right ventricular pressure were decreased at 2.5 h (26.5±11.4)mmHg and 4 h (24.8±9.3)mmHg after ROSC compared with the level during CA (46.2±13.01)mmHg (P<0.05). The systemic vascular resistance peaked at 4 h after ROSC. The pulmonary vascular resistance level at ROSC was higher than the baseline [(96.5±24.8)DS/cm5 vs. (26.5±13.4)DS/cm5, P<0.05], and was decreased at 1 h and 2 h after ROSC, but was increased at 4 h and 6 h after ROSC [(98.5±0.7)DS/cm5 and (98.0±1.4)DS/cm5]. The changes of heart function: compared with the baseline, the left ventricular function at ROSC and 1-6 h after ROSC were declined significantly (all P<0.05), and right cardiac output declined at ROSC and 4 h and 6 h after ROSC (all P<0.05), and the level of cardiac function index was dropped at 1 h and 2 h after ROSC (P<0.05). Conclusions The mean arterial pressure was declined, mean pulmonary arterial pressure, right ventricular pressure and pulmonary vascular resistance were increased, cardiac function was decreased during CA induced by acute pulmonary embolism; After ROSC, hemodynamic changes were described as compensated in the early stage (1-2 h after ROSC) and decompensated (4 h after ROSC) with time.
RESUMO
Objective To investigate the clinical significance of detecting the level of D-dimer and fibrino-gen degradation products(FDP)in the prognosis of acute pulmonary embolism(APE).Methods The plasma D-dimer and FDP levels in patients with APE were determined by the method of turbidimetric inhibition im-muno assay in 126 patients with respiratory medicine of Renmin Hospital of Wuhan University.According to the severity of APE patients,they were classified into high-risk group,middle risk group and Low-risk Group. According to the 6-month clinical outcome after treatment,the patients were divided into survival group and death group,and evaluate the predictive value of D-dimer and FDP levels in assessing the prognosis of patients with APE.Results With the increase in the severity of APE,the levels of D-dimer and FDP were significantly increased(P<0.05).The levels of D-dimer and FDP were significantly higher in the death group than those in the survivor group(P<0.05).The D-dimer and FDP level were positively correlated(r=0.437,P=0.000). ROC curve analysis showed that D-dimer>0.98 mg/L and FDP>10.02 mg/L had a higher prognostic value for APE Patients.Conclusion D-dimer and FDP levels are associated with the risk stratification and long-term prognosis of APE patients.Meanwhile,the combination of D-dimer and FDP can improve the accuracy of the disease severity and prognosis of APE patients,which deserves extensive attention in the new situation of clin-ical personalized medical care.
RESUMO
Objective To analyze the distribution of traditional Chinese medicine(TCM)syndromes in patients with acute pulmonary embolism(APE)and to summarize the medication rule,so as to supply evidence for the clinical diagnosis and treatment of APE. Methods A retrospective study was carried out in the APE inpatients admitted in the First Affiliated Hospital of Guangzhou University of Chinese Medicine in recent 4 years. The general data, clinical manifestations at the attack of APE, TCM syndromes, treatment and prognosis of the included patients were input into the database for the analysis of TCM syndrome distribution and medication rule. Results A total of 139 cases of APE patients were included into the study. The main manifestations at admission were dominated by dyspnea and chest pain, pale or darkish red tongue, string pulse and deep pulse. TCM syndromes were divided into three types, phlegm turbidity syndrome, blood stasis syndrome and yang collapse syndrome. The blood stasis syndrome accounted for the largest proportion and then came the phlegm turbidity syndrome. In various age groups,the 3 syndrome types accounted the highest proportion in the age group of 51-70 years old, and accounted higher proportion in the age group over 71 years old. Blood stasis syndrome was frequently seen in the age group below 30 years old. Xuefu Zhuyu Decoction and Tao Hong Siwu Decoction were frequently used for the treatment of blood stasis syndrome, Gualou Xiebai Banxia Decoction and Wendan Decoction were often used for the phlegm turbidity syndrome, and Shenfu Injection was often used for yang collapse syndrome. Conclusion APE occurs in various clinical departments, and phlegm turbidity syndrome, blood stasis syndrome and yang collapse syndrome are the main syndrome patterns of APE. Blood stasis syndrome accounts the largest proportion in clinic. Therefore, Xuefu Zhuyu Decoction and Tao Hong Siwu Decoction, Gualou Xiebai Banxia Decoction and Wendan Decoction should be used as the indicated recipes for APE to activate blood and remove stasis, strengthen spleen and resolve phlegm.
RESUMO
Resumen: La hipertensión pulmonar tromboembólica crónica (HPTEC) es un subtipo de hipertensión pulmonar (HP) caracterizada por la obstrucción mecánica de las arterias pulmonares causada por una tromboembolia pulmonar. Sin tratamiento es una enfermedad progresiva y devastadora, y es el único subgrupo de HP potencialmente curable mediante la endarterectomía pulmonar. La magnitud, así como la recurrencia de la embolia pulmonar, son determinantes y contribuyen al desarrollo de la HPTEC aun cuando está asociada solo a algunos factores trombofílicos. Una hipótesis es que la enfermedad es consecuencia de la resolución incompleta y la organización del trombo, favorecido por fenómenos de inflamación, inmunitarios y/o genéticos que promueven el desarrollo de estenosis de tipo fibroso que culminan con el remodelado vascular oclusivo de vasos proximales y distales. Los mecanismos involucrados en la fallida resolución del trombo aún no están esclarecidos. Los pacientes con HPTEC con frecuencia exhiben HP severa que no puede ser explicada por el grado de obstrucción vascular demostrada en estudios por imagen. En tales casos la arteriopatía pulmonar y las lesiones trombóticas obstructivas, distales al nivel subsegmentario, pueden contribuir al incremento fuera de proporción de las resistencias vasculares pulmonares. Los procesos que llevan al desarrollo de la arteriopatía pulmonar y los cambios microvasculares que ocurren en la HPTEC explican el comportamiento progresivo de la HP y el deterioro clínico gradual con pobre pronóstico para los pacientes, así como también la falta de correlación entre la magnitud de la obstrucción vascular y la medición de parámetros hemodinámicos, aun en ausencia de tromboembolismo venoso recurrente. Esta revisión resume los aspectos más relevantes y actuales de la patobiología y fisiopatología de la HPTEC.
Abstract: Chronic thromboembolic pulmonary hypertension (CTEPH) represents a unique subtype of pulmonary hypertension characterized by the presence of mechanical obstruction of the major pulmonary vessels caused by venous thromboembolism. CTEPH is a progressive and devastating disease if not treated, and is the only subset of PH potentially curable by a surgical procedure known as pulmonary endarterectomy. The clot burden and pulmonary embolism recurrence may contribute to the development of CTEPH however only few thrombophilic factors have been found to be associated. A current hypothesis is that CTEPH results from the incomplete resolution and organization of thrombus modified by inflammatory, immunologic and genetic mechanisms, leading to the development of fibrotic stenosis and adaptive vascular remodeling of resistance vessels. The causes of thrombus non-resolution have yet to be fully clarified. CTEPH patients often display severe PH that cannot be fully explained by the degree of pulmonary vascular obstruction apparent on imaging studies. In such cases, the small vessel disease and distal obstructive thrombotic lesions beyond the sub-segmental level may contribute for out of proportion elevated PVR. The processes implicated in the development of arteriopathy and microvascular changes might explain the progressive nature of PH and gradual clinical deterioration with poor prognosis, as well as lack of correlation between measurable hemodynamic parameters and vascular obstruction even in the absence of recurrent venous thromboembolism. This review summarizes the most relevant up-to-date aspects on pathobiology and pathophysiology of CTEPH.
Assuntos
Humanos , Embolia Pulmonar/complicações , Embolia Pulmonar/fisiopatologia , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/fisiopatologia , Doença Aguda , Doença CrônicaRESUMO
Acute pulmonary embolism is a life threatening condition with a high mortality rate. If diagnosed early, the patient outcome is better. Therefore, early assessment, diagnosis and appropriate treatment are a key to successful management of the patient. This article discusses two (2) cases of acute pulmonary embolism of different aetiologies and also undertakes a review of the literature with regards to classification systems, risk stratification, diagnostic tools and recent advances in management of pulmonary embolism.