ABSTRACT
OBJECTIVE: The aim of this study was to describe the Computed Tomography (CT) features of pulmonary embolism in patients hospitalized for acute COVID-19 pneumonia and to evaluate the prognostic significance of these features. PATIENTS AND METHODS: This retrospective study included 110 consecutive patients who were hospitalized for acute COVID-19 pneumonia and underwent pulmonary computed tomography angiography (BTPA) on the basis of clinical suspicion. The diagnosis of COVID-19 infection was determined by CT findings typical of COVID-19 pneumonia and/or a positive result of a reverse transcriptase-polymerase chain reaction test. RESULTS: Of the 110 patients, 30 (27.3%) had acute pulmonary embolism and 71 (64.5%) had CT features of chronic pulmonary embolism. Of the 14 (12.7%) patients who died despite receiving therapeutic doses of heparin, 13 (92.9%) had CT features of chronic pulmonary embolism and 1 (7.1%) of acute pulmonary embolism. CT features of chronic pulmonary embolism were more common in deceased patients than in surviving patients (92.9% vs. 60.4%, p=0.01, respectively). Low oxygen saturation and high urine microalbumin creatinine ratio at admission in COVID-19 patients are important determinants of mortality after adjusting for sex and age in logistic procedures. CONCLUSIONS: CT features of chronic pulmonary embolism are common in COVID-19 patients undergoing Computed Tomography Pulmonary Angiography (CTPA) in the hospital. The coexistence of albuminuria, low oxygen saturation and CT features of chronic pulmonary embolism at admission in COVID-19 patients may herald fatal outcomes.
Subject(s)
COVID-19 , Pulmonary Embolism , Humans , COVID-19/complications , COVID-19/diagnostic imaging , Retrospective Studies , Pulmonary Embolism/diagnostic imaging , Tomography, X-Ray Computed , Lung/diagnostic imaging , Acute DiseaseABSTRACT
Coronavirus disease 2019 (COVID-19) is an infection caused by SARS-CoV-2 that has caused an unprecedented pandemic with a high rate of morbidity and mortality worldwide. Although most cases are mild, there are a considerable number of patients who develop pneumonia or even acute respiratory distress syndrome (ARDS). After having recovered from the initial disease, many patients continue with various symptoms (fatigue, dry cough, fever, dyspnea, anosmia, and chest pain, among others.), which has led to consider the possible existence of "post-COVID-19 syndrome". Although the definition and validity of this syndrome are not clear yet, several studies report that individuals who have recovered from COVID-19 may have persistent symptoms, radiological abnormalities, and compromised respiratory function. Current evidence suggests that there is a large number of pulmonary sequelae after COVID-19 pneumonia (interstitial thickening, ground glass opacities, crazy paving pattern, and bronchiectasis, among others.). Likewise, it seems that pulmonary function tests (spirometry, DLCO, 6MWT, and measurement of maximum respiratory pressures), in addition to high-resolution computed axial tomographies (CAT scan), are useful for the assessment of these post-COVID-19 pulmonary sequelae. This review aims to describe the possible pulmonary sequelae after COVID-19 pneumonia, as well as to suggest diagnostic procedures for their correct assessment and follow-up; thus, allowing proper management by a multidisciplinary medical team.
COVID-19 es la enfermedad causada por el virus SARS-CoV-2, la cual ha ocasionado una pandemia sin precedentes, con gran cantidad de infectados y muertos en el mundo. Aunque la mayoría de los casos son leves, existe una cantidad considerable de pacientes que desarrollan neumonía o, incluso, síndrome de distrés respiratorio agudo (SDRA). Luego de recuperarse del cuadro inicial, muchos pacientes continúan con diversos síntomas (fatiga, tos seca, fiebre, disnea, anosmia, dolor torácico, entre otras), lo que ha llevado a considerar la posible existencia del "síndrome pos-COVID-19". Aunque la definición y validez de este síndrome aún no son claras, varios estudios reportan que los individuos recuperados de la COVID-19 pueden tener persistencia de síntomas, anormalidades radiológicas y compromiso en la función respiratoria. La evidencia actual sugiere que existe gran cantidad de secuelas pulmonares despues de una neumonía por COVID-19 (engrosamiento intersticial, infiltrado en vidrio esmerilado, patrón en empedrado, bronquiectasias, entre otras.). De igual forma, parece ser que las pruebas de función pulmonar (espirometría, prueba de difusión pulmonar de monóxido de carbono, prueba de caminata de seis minutos y la medición de las presiones respiratorias máximas), además de la tomografía axial computarizada de alta resolución, son útiles para evaluar las secuelas pulmonares pos-COVID-19. En esta revisión se pretende describir las posibles secuelas a nivel pulmonar posteriores a neumonía por COVID-19, así como sugerir procedimientos diagnósticos para su correcta evaluación y seguimiento, que permitan el manejo adecuado por parte de un equipo médico multidisciplinario.
Subject(s)
COVID-19/complications , Convalescence , Lung Diseases/etiology , Respiratory Distress Syndrome/etiology , Bronchiectasis/diagnostic imaging , Bronchiectasis/etiology , Bronchiectasis/physiopathology , Disease Progression , Follow-Up Studies , Humans , Hypoxia/blood , Hypoxia/etiology , Hypoxia/physiopathology , Lung Diseases/diagnostic imaging , Lung Diseases, Interstitial/diagnostic imaging , Lung Diseases, Interstitial/etiology , Lung Diseases, Interstitial/physiopathology , Mental Disorders/etiology , Mental Disorders/physiopathology , Oxygen/blood , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/etiology , Pulmonary Embolism/physiopathology , Respiratory Distress Syndrome/physiopathology , Respiratory Function Tests , Spirometry , Tomography, X-Ray ComputedABSTRACT
PURPOSE: To evaluate myocardial status through the assessment of extracellular volume (ECV) calculated at computed tomography (CT) in patients hospitalized for novel coronavirus disease (COVID-19), with regards to the presence of pulmonary embolism (PE) as a risk factor for cardiac dysfunction. METHOD: Hospitalized patients with COVID-19 who underwent contrast-enhanced CT at our institution were retrospectively included in this study and grouped with regards to the presence of PE. Unenhanced and portal venous phase scans were used to calculate ECV by placing regions of interest in the myocardial septum and left ventricular blood pool. ECV values were compared between patients with and without PE, and correlations between ECV values and clinical or technical variables were subsequently appraised. RESULTS: Ninety-four patients were included, 63/94 of whom males (67%), with a median age of 70 (IQR 56-76 years); 28/94 (30%) patients presented with PE. Patients with PE had a higher myocardial ECV than those without (33.5%, IQR 29.4-37.5% versus 29.8%, IQR 25.1-34.0%; p = 0.010). There were no correlations between ECV and patients' age (p = 0.870) or sex (p = 0.122), unenhanced scan voltage (p = 0.822), portal phase scan voltage (p = 0.631), overall radiation dose (p = 0.569), portal phase scan timing (p = 0.460), and contrast agent dose (p = 0.563). CONCLUSIONS: CT-derived ECV could help identify COVID-19 patients at higher risk of cardiac dysfunction, especially when related to PE, to potentially plan a dedicated, patient-tailored clinical approach.
Subject(s)
COVID-19 , Heart Diseases , Pulmonary Embolism , Male , Humans , Middle Aged , Aged , Retrospective Studies , Myocardium , Tomography, X-Ray Computed/methods , Pulmonary Embolism/diagnostic imagingSubject(s)
COVID-19 Vaccines , Cardiovascular Diseases , Immunization, Secondary , Vaccines, Combined , Humans , Cardiovascular Diseases/chemically induced , Cardiovascular Diseases/diagnostic imaging , Cardiovascular Diseases/etiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , COVID-19 Vaccines/therapeutic use , Immunization, Secondary/adverse effects , Myocardial Infarction/chemically induced , Myocardial Infarction/etiology , Pulmonary Embolism/chemically induced , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/etiology , Stroke/chemically induced , Stroke/etiology , Vaccines, Combined/adverse effects , Vaccines, Combined/therapeutic useABSTRACT
Background: A little is known about the risk factors and predictors of pulmonary embolism (PE) in Coronavirus disease 2019 (Covid-19) infected patients. Therefore, we directed this study to investigate the predictors of PE in patients infected with Covid - 19 in Upper Egypt. Methods: We conducted a retrospective cohort study on 297 patients infected with COVID-19, aged ≥ 18 years old. Suspicion of COVID-19 infection was based on the World Health Organization (WHO) criteria and confirmed by nasal and pharyngeal swab for real-time reverse transcriptase-polymerase chain reaction (RT-PCR) analysis. The patient was also determined to have COVID-19 when CT results that were thought to be typical for COVID-19 and clinical data that were compatible were present. Results: PE was diagnosed in 18.2% of patients. We found that the incidence of PE was significantly higher in older patients, females, those with higher BMI, hypertensive patients, diabetics, and patients with co-morbidities. Also, PE was significantly higher in patients presented with dyspnea, chest pain, longer duration of symptoms at hospital admission, and lower oxygen concentration. The mean serum Hb level, platelet count, TLC and absolute lymphocytic count were markedly reduced in those who had PE. All the patients who developed PE had a CO-RADS scale five on their CT chest scan. Age > 65, BMI > 25, DM, and associated co-morbidities were the independent patients' characteristics associated with the development of PE after the multivariate regression analysis. Conclusion: PE is a common complication of Covid 19 infection. PE is associated with a variety of clinical and laboratory parameters in univariate analysis, but age > 65, BMI > 25, DM, and associated co-morbidities were the independent patients' characteristics associated with the development of PE in those infected with Covid-19.
Subject(s)
COVID-19 , Pulmonary Embolism , Female , Humans , Aged , Adolescent , COVID-19/complications , COVID-19/diagnosis , COVID-19/epidemiology , SARS-CoV-2 , Retrospective Studies , Egypt/epidemiology , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/epidemiologyABSTRACT
BACKGROUND: Coronavirus disease 2019 was spread worldwide, as a pandemic, from December 2019. Venous thromboembolism events can inflict patients with coronavirus disease 2019 during the hospitalization or convalescent period. Therefore, monitoring of these patients, in terms of venous thromboembolism events signs and symptoms, and timely management of antithrombotic agents are of great importance. CASE REPORT: A 45-year-old Iranian man, who is the first author of this case report, was infected by severe acute respiratory syndrome coronavirus 2 and displayed the typical signs and symptoms of coronavirus disease 2019. Although reverse transcription polymerase chain reaction for coronavirus disease 2019, and specific immunoglobulin M and immunoglobulin G against severe acute respiratory syndrome coronavirus 2, were negative at first, chest computed tomography scan showed the characteristic pattern of lung involvement of a coronavirus disease 2019 infection including bilateral and multilobar ground-glass opacities. At that time, there were no signs or symptoms of deep-vein thrombosis or pulmonary thromboembolism, so these were not investigated. About 30 hours after hospital discharge, the patient presented back to the hospital with acute-onset chest pain. We instantly tested his blood for D-dimer, and sent him to take a Doppler sonography of his lower legs and a chest computed tomography angiography in search of pulmonary thromboembolism and deep-vein thrombosis. Although we could confirm pulmonary thromboembolism with computed tomography angiography in our patient, there were no signs or symptoms of venous thromboembolism in his lower legs, and color Doppler sonography of lower limbs was normal. So, the patient was treated with rivaroxaban as an antithrombotic agent. After some days, he was discharged in good condition. About 1 month later, he was referred to our hospital because of left lower limb edema. Although he was under antithrombotic therapy, color Doppler sonography of lower limbs revealed acute deep-vein thrombosis of the left leg. Hence, we decided to shift antithrombotic therapy from rivaroxaban to warfarin, as it is more potent than rivaroxaban in recurrent venous thromboembolism and when taking new oral anticoagulants. Unlike rivaroxaban, which needs no blood test to monitor its efficacy but has a warning for signs and symptoms of bleeding, warfarin therapy must be monitored carefully by regular blood tests for prothrombin time and international normalized ratio to maintain them in the therapeutic range. The patient was informed about the bleeding cautions, and required regular check of prothrombin time and international normalized ratio to maintain them in the proper and advised range of treatment (international normalized ratio therapeutic range 2-3). CONCLUSION: In the case of unexpected recurrent venous thromboembolism in coronavirus disease 2019, especially when patients are taking rivaroxaban or other new oral anticoagulants, such drugs should be substituted by warfarin, with routine follow-up, to maintain the value of prothrombin time and international normalized ratio within the therapeutic range.
Subject(s)
COVID-19 , Pulmonary Embolism , Venous Thromboembolism , Venous Thrombosis , Male , Humans , Middle Aged , Warfarin/therapeutic use , Venous Thromboembolism/diagnostic imaging , Venous Thromboembolism/drug therapy , Venous Thromboembolism/etiology , Rivaroxaban/therapeutic use , COVID-19/complications , Fibrinolytic Agents/therapeutic use , Iran , Anticoagulants , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/drug therapy , Venous Thrombosis/etiology , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/drug therapy , Pulmonary Embolism/complications , Hemorrhage/chemically induced , SARS-CoV-2 , Decision MakingABSTRACT
INTRODUCTION: The co-existence of coronavirus disease 2019 (COVID-19) and pulmonary thromboembolic (PTE) disease poses a great clinical challenge. To date, few researches have addressed this important clinical issue among the South-East Asian populations. The objectives of this study were as follow: (1) to describe the clinical characteristics and computed tomographical (CT) features of patients with PTE disease associated with COVID-19 infection and (2) to compare these parameters with those COVID-19 patients without PTE disease. MATERIALS AND METHODS: This cross-sectional study with retrospective record review was conducted in Hospital Tengku Ampuan Rahimah, Selangor, Malaysia. We included all hospitalised patients with confirmed COVID-19 infection who had undergone CT pulmonary angiogram (CTPA) examinations for suspected PTE disease between April 2021 and May 2021. Clinical data and laboratory data were extracted by trained data collectors, whilst CT images retrieved were analysed by a senior radiologist. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 20. RESULTS: We studied 184 COVID-19 patients who were suspected to have PTE disease. CTPA examinations revealed a total of 150 patients (81.5%) suffered from concomitant PTE disease. Among the PTE cohort, the commonest comorbidities were diabetes mellitus (n=78, 52.0%), hypertension (n=66, 44.0%) and dyslipidaemia (n=25, 16.7%). They were generally more ill than the non-PTE cohort as they reported a significantly higher COVID-19 disease category during CTPA examination with p=0.042. Expectedly, their length of both intensive care unit stays (median number of days 8 vs. 3; p=0.021) and hospital stays (median number of days 14.5 vs. 12; p=0.006) were significantly longer. Intriguingly, almost all the subjects had received either therapeutic anticoagulation or thromboprophylactic therapy prior to CTPA examination (n=173, 94.0%). Besides, laboratory data analysis identified a significantly higher peak C-reactive protein (median 124.1 vs. 82.1; p=0.027) and ferritin levels (median 1469 vs. 1229; p=0.024) among them. Evaluation of CT features showed that COVID-19 pneumonia pattern (p<0.001) and pulmonary angiopathy (p<0.001) were significantly more profound among the PTE cohort. To note, the most proximal pulmonary thrombosis was located in the segmental (n=3, 2.0%) and subsegmental pulmonary arteries (n=147, 98.0%). Also, the thrombosis predominantly occurred in bilateral lungs with multilobar involvement (n=95, 63.3%). CONCLUSION: Overall, PTE disease remains prevalent among COVID-19 patients despite timely administration of thromboprophylactic therapy. The presence of hyperinflammatory activities, unique thrombotic locations as well as concurrent pulmonary parenchyma and vasculature aberrations in our PTE cohort implicate immunothrombosis as the principal mechanism of this novel phenomenon. We strongly recommend future researchers to elucidate this important clinical disease among our post- COVID vaccination populations.
Subject(s)
COVID-19 , Lung Diseases , Pulmonary Embolism , Thrombosis , Humans , COVID-19/complications , COVID-19/diagnostic imaging , Tertiary Care Centers , Retrospective Studies , Cross-Sectional Studies , Neovascularization, Pathologic , Pulmonary Circulation , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/etiology , Tomography, X-Ray Computed/methodsABSTRACT
BACKGROUND: Diagnosing concomitant pulmonary embolism (PE) in COVID-19 patients remains challenging. As such, PE may be overlooked. We compared the diagnostic yield of systematic PE-screening based on the YEARS-algorithm to PE-screening based on clinical gestalt in emergency department (ED) patients with COVID-19. METHODS: We included all ED patients who were admitted because of COVID-19 between March 2020 and February 2021. Patients already receiving anticoagulant treatment were excluded. Up to April 7, 2020, the decision to perform CT-pulmonary angiography (CTPA) was based on physician's clinical gestalt (clinical gestalt cohort). From April 7 onwards, systematic PE-screening was performed by CTPA if D-dimer level was ≥1000 ug/L, or ≥500 ug/L in case of ≥1 YEARS-item (systematic screening cohort). RESULTS: 1095 ED patients with COVID-19 were admitted. After applying exclusion criteria, 289 were included in the clinical gestalt and 574 in the systematic screening cohort. The number of PE diagnoses was significantly higher in the systematic screening cohort compared to the clinical gestalt cohort: 8.2% vs. 1.0% (3/289 vs. 47/574; p<0.001), even after adjustment for differences in patient characteristics (adjusted OR 8.45 (95%CI 2.61-27.42, p<0.001) for PE diagnosis). In multivariate analysis, D-dimer (OR 1.09 per 1000 µg/L increase, 95%CI 1.06-1.13, p<0.001) and CRP >100 mg/L (OR 2.78, 95%CI 1.37-5.66, p = 0.005) were independently associated with PE. CONCLUSION: In ED patients with COVID-19, the number of PE diagnosis was significantly higher in the cohort that underwent systematic PE screening based on the YEARS-algorithm in comparison with the clinical gestalt cohort, with a number needed to test of 7.1 CTPAs to detect one PE.
Subject(s)
COVID-19 , Pulmonary Embolism , Humans , COVID-19/complications , COVID-19/diagnosis , Pulmonary Embolism/diagnostic imaging , Patients , Fibrin Fibrinogen Degradation Products/analysis , Emergency Service, Hospital , Retrospective Studies , COVID-19 TestingSubject(s)
Aortic Diseases , COVID-19 , Pulmonary Embolism , Severe Acute Respiratory Syndrome , Thrombosis , Humans , COVID-19/complications , Severe Acute Respiratory Syndrome/complications , Pulmonary Embolism/complications , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/drug therapy , Thrombosis/complications , Thrombosis/diagnostic imaging , Thrombosis/drug therapy , Aortic Diseases/complications , Aortic Diseases/diagnostic imaging , Acute DiseaseABSTRACT
ABSTRACT: Although COVID-19 infection is associated with the increased risk of pulmonary thromboembolism (PTE), COVID-19 pulmonary lesions cause ventilation-perfusion (V/Q) patterns other than PTE. Although extensive research has been done to address different anatomical patterns of COVID-19, there is a knowledge gap in terms of V/Q lung scintigraphy in these patients. The purpose of this study is to demonstrate these patterns and to show how important it is to use SPECT/CT in addition to planar images to differentiate between these patterns from PTE. In the current collection, we presented various patterns of V/Q SPECT/CT abnormalities in COVID-19 patients.
Subject(s)
COVID-19 , Pulmonary Embolism , Humans , Ventilation-Perfusion Scan , Tomography, Emission-Computed, Single-Photon/methods , COVID-19/diagnostic imaging , Lung/diagnostic imaging , Pulmonary Embolism/diagnostic imaging , Ventilation-Perfusion Ratio , PerfusionABSTRACT
The SARS-CoV-2 virus, or COVID-19, is responsible for the current global pandemic and has resulted in the death of over 400,000 in the United States. Rates of venous thromboembolism have been noted to be much higher in those infected with COVID-19. Here we report a case-series of COVID-19 patients with diverse presentations of pulmonary embolism (PE). We also briefly describe the pathophysiology and mechanisms for pulmonary embolism in COVID-19. These cases indicate a need to maintain a high index of suspicion for PE in patients with COVID-19, as well as the need to consider occult COVID-19 infection in patients with PE in the right clinical circumstance.
Subject(s)
COVID-19 , Pulmonary Embolism , SARS-CoV-2 , Acute Disease , Adult , COVID-19/complications , COVID-19/diagnostic imaging , COVID-19/epidemiology , COVID-19/physiopathology , Humans , Male , Middle Aged , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/epidemiology , Pulmonary Embolism/etiology , Pulmonary Embolism/physiopathology , United States/epidemiologyABSTRACT
BACKGROUND: Anticoagulant treatment is recommended for at least three months after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related acute pulmonary embolism (PE), but the persistent pulmonary clot burden after that time is unknown. METHODS: Lung perfusion was assessed by ventilation-perfusion (V/Q) SPECT/CT in 20 consecutive patients with SARS-CoV-2-associated acute PE after a minimum of three months anticoagulation therapy in a retrospective observational study. RESULTS: Remaining perfusion defects after a median treatment period of six months were observed in only two patients. All patients (13 men, seven women, mean age 55.6 ± 14.5 years) were on non-vitamin K direct oral anticoagulants (DOACs). No recurrent venous thromboembolism or anticoagulant-related bleeding complications were observed. Among patients with partial clinical recovery, high-risk PE and persistent pulmonary infiltrates were significantly more frequent (p < 0.001, respectively). INTERPRETATION: Temporary DOAC treatment seems to be safe and efficacious for resolving pulmonary clot burden in SARS-CoV-2-associated acute PE. Partial clinical recovery is more likely caused by prolonged SARS-CoV-2-related parenchymal lung damage rather than by persistent pulmonary perfusion defects.
Subject(s)
COVID-19 , Pulmonary Embolism , Male , Humans , Female , Adult , Middle Aged , Aged , SARS-CoV-2 , COVID-19/complications , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/drug therapy , Lung/diagnostic imaging , Single Photon Emission Computed Tomography Computed Tomography , Anticoagulants/therapeutic use , Acute Disease , PerfusionABSTRACT
ABSTRACT: Invented and first approved for clinical use in Australia 36 years ago, Technegas is the technology that enabled ventilation scintigraphy with 99m Tc-labeled carbon nanoparticles ( 99m Tc-CNP). The US Food and Drug Administration (FDA) has considered this technology for more than 30 years but only now is getting close to approving it. Meanwhile, more than 4.4 million patients benefited from this technology in 64 countries worldwide. The primary application of 99m Tc-CNP ventilation imaging is the diagnostic evaluation for suspicion of pulmonary embolism using ventilation-perfusion quotient (V/Q) imaging. Because of 99m Tc-CNP's long pulmonary residence, tomographic imaging emerged as the preferred V/Q methodology. The FDA-approved ventilation imaging agents are primarily suitable for planar imaging, which is less sensitive. After the FDA approval of Technegas, the US practice will likely shift to tomographic V/Q. The 99m Tc-CNP use is of particular interest in the COVID-19 pandemic because it offers an option of a dry radioaerosol that takes approximately only 3 to 5 tidal breaths, allowing the shortest exposure to and contact with possibly infected patients. Indeed, countries where 99m Tc-CNP was approved for clinical use continued using it throughout the COVID-19 pandemic without known negative viral transmission consequences. Conversely, the ventilation imaging was halted in most US facilities from the beginning of the pandemic. This review is intended to familiarize the US clinical nuclear medicine community with the basic science of 99m Tc-CNP ventilation imaging and its clinical applications, including common artifacts and interpretation criteria for tomographic V/Q imaging for pulmonary embolism.
Subject(s)
COVID-19 , Pulmonary Embolism , Humans , Carbon , COVID-19/diagnostic imaging , Lung , Pandemics , Pulmonary Embolism/diagnostic imaging , Pulmonary Ventilation , Radionuclide Imaging , Respiratory Aerosols and Droplets , Technetium , Ventilation-Perfusion Ratio , NanostructuresABSTRACT
OBJECTIVE: It was aimed to reveal the continuing perfusion defect rates in patients with a diagnosis of pulmonary embolism (PE) due to COVID-19 who have completed the third month of anticoagulant therapy but whose symptoms or laboratory elevations continue. METHODS: Patients with COVID-19 who were diagnosed with PE by Q-SPECT-CT between 1 September 2020 and 1 November 2021, who underwent control Q-SPECT/CT were included in the study. Demographic characteristics, laboratory findings, and first and second Q-SPECT/CT evaluation results of the patients were recorded. RESULTS: It was observed that the pulmonary defect continued in Q-SPECT/CT in the third month of anticoagulant treatment in 58.3% of the patients diagnosed with PE due to COVID-19, and new defects developed in 6.3%. The persistence rate of segment defects was higher than that of subsegment defects. It was observed that the defects persisted more frequently in patients with a history of hospitalization due to COVID-19. CONCLUSION: Perfusion defects may still be present in patients diagnosed with PE due to COVID-19 in the presence of persistent dyspnea/chest pain/D-dimer elevation after 3 months of treatment. Perfusion defect persistence rates are higher in defects more proximal to the subsegment level and in people with severe COVID-19, and extended treatment should be considered in these patients.
Subject(s)
COVID-19 , Pulmonary Embolism , Anticoagulants/therapeutic use , COVID-19/complications , Humans , Perfusion , Pulmonary Embolism/complications , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/drug therapy , Tomography, Emission-Computed, Single-Photon/methodsABSTRACT
Background. Fixed-dose ultrasound-assisted catheter-directed thrombolysis (USAT) rapidly improves hemodynamic parameters and reverses right ventricular dysfunction caused by acute pulmonary embolism (PE). The effectiveness of USAT for acute PE associated with coronavirus disease 2019 (COVID-19) is unknown. Methods and results. The study population of this cohort study consisted of 36 patients with an intermediate-high- or high-risk acute PE treated with a fixed low-dose USAT protocol (r-tPA 10-20 mg/15 h). Of these, 9 patients tested positive for COVID-19 and were age-sex-matched to 27 patients without COVID-19. The USAT protocol included, beyond the infusion of recombinant tissue plasminogen activator, anti-Xa-activity-adjusted unfractionated heparin therapy (target 0.3-0.7 U/mL). The study outcomes were the invasively measured mean pulmonary arterial pressure (mPAP) before and at completion of USAT, and the National Early Warning Score (NEWS), according to which more points indicate more severe hemodynamic impairment. Twenty-four (66.7%) patients were men; the mean age was 67 ± 14 years. Mean ± standard deviation mPAP decreased from 32.3 ± 8.3 to 22.4 ± 7.0 mmHg among COVID-19 patients and from 35.4 ± 9.7 to 24.6 ± 7.0 mmHg among unexposed, with no difference in the relative improvement between groups (p = 0.84). Within 12 h of USAT start, the median NEWS decreased from six (Q1-Q3: 4-8) to three (Q1-Q3: 2-4) points among COVID-19 patients and from four (Q1-Q3: 2-6) to two (Q1-Q3: 2-3) points among unexposed (p = 0.29). One COVID-19 patient died due to COVID-19-related complications 14 days after acute PE. No major bleeding events occurred. Conclusions. Among patients with COVID-19-associated acute PE, mPAP rapidly decreased during USAT with a concomitant progressive improvement of the NEWS. The magnitude of mPAP reduction was similar in patients with and without COVID-19.
Subject(s)
COVID-19 Drug Treatment , COVID-19 , Pulmonary Embolism , Acute Disease , Aged , Aged, 80 and over , COVID-19/complications , Catheters , Cohort Studies , Female , Heparin , Humans , Male , Middle Aged , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/drug therapy , Retrospective Studies , Thrombolytic Therapy/methods , Tissue Plasminogen Activator/therapeutic use , Treatment OutcomeABSTRACT
PURPOSE: This retrospective review examines the incidence of pulmonary embolism (PE) during computed tomography pulmonary angiography (CTPA) exams performed in the emergency room setting of a tertiary care center over dominant periods of the ancestral, Delta, and Omicron variants of COVID-19. MATERIALS/METHODS: Demographic information, patient comorbidities and risk factors, vaccination status, and COVID-19 infection status were collected from patient's charts. Incidence of PE in COVID positive patients was compared between variant waves. Subgroup analysis of vaccination effect was performed. RESULTS: CTPA was ordered in 18.3% of COVID-19 positive patients during the ancestral variant period, 18.3% during the Delta period and 17.3% during the Omicron wave. PE was seen in 15.0% of the ancestral COVID-19 variant cohort, 10.6% in the Delta COVID cohort and 9.23% of the Omicron cohort, reflecting a 41% and 60% increased risk of PE with ancestral variants compared to Delta and Omicron periods respectively. The study however was underpowered and the difference in rate of PE did not reach statistically significance (p = 0.43 and p = 0.22). Unvaccinated patients had an 2.75-fold increased risk of COVID-associated PE during the Delta and Omicron periods (p = .02) compared to vaccinated or recovered patients. CONCLUSION: Vaccination reduces the risk of COVID-19 associated PE. Patients infected with the Delta and Omicron COVID-19 variants may have a lower incidence of pulmonary embolism, though a larger or multi-institution study is needed to prove definitively.