RESUMEN
Resumen Introducción: El aumento de la concentración de dímero-D en pacientes COVID-19 se ha asociado a mayor gravedad y peor pronóstico; sin embargo, su rol en predecir el diagnóstico de tromboembolismo pulmonar (TEP), aún es incierto. Objetivo: Evaluar la utilidad del dímero-D plasmático en el diagnóstico de TEP en pacientes con COVID-19. Pacientes y Métodos: Estudio observacional analítico. Se incluyó a pacientes COVID-19 que tenían una angiotomografía computada de tórax (AngioTAC). Se registraron datos clínicos, niveles plasmáticos de dímero-D de ingreso y previo al momento de realizar la AngioTAC. Se identificó la presencia o ausencia de TEP. Resultados: Se incluyeron 163 pacientes; 37(23%) presentaron TEP. Al comparar la serie de pacientes con TEP versus sin TEP, no se encontraron diferencias significativas en características clínicas, ni mortalidad. Hubo diferencias significativas en el nivel plasmático del dímero-D previo a realizar la AngioTAC (3.929 versus 1.912 μg/L; p = 0,005). El área bajo la curva ROC del dímero-D para TEPfue de 0,65. El mejor punto de corte del dímero-D fue de 2.000 μg/L, con una baja sensibilidad y valor predictivo positivo. El valor de corte con el mejor valor predictivo negativo (VPN)fue de 900 μg/L (96%), el cual fue mejor que la estrategia de corte de dímero D ajustado por edad (VPN 90%). Conclusión: La capacidad discriminativa del dímero D para diagnosticar TEP fue baja. En cambio, el dímero D mantiene un alto valor predictivo negativo para descartar TEP, el cual es mayor al valor descrito clásicamente en los pacientes no COVID.
Introduction: Increased D-dimer concentration in COVID-19 patients has been associated with greater severity and worse prognosis; however its role in predicting the diagnosis of pulmonary thromboembolism (PTE), is still uncertain. Objective: To evaluate the usefulness of plasma D-dimer in the diagnosis of PTE in patients with COVID-19. Method: Analytical observational study. COVID-19 patients who had a chest computed tomography angiography (CTA) were included. Clinical data, Ddimer plasma levels on admission and prior to CTA were recorded. The presence or absence of PTE was identified. Results: 163 patients were included, 37 (23%) presented PTE. After comparing the series of patients with PTE versus the series without PTE, no significant differences were found in clinical characteristics or mortality. There were significant differences in the plasma level of D-dimer prior to performing CTA (3,929 μg/L versus. 1,912 μg/L; p = 0.005). The area under the D-dimer ROC curve for PTEprediction was 0.65. The best D-dimer cutoffpoint was 2.000μg/L, with a low sensitivity and positivepredictive value. The cutoff value with the best negativepredictive value (NPV) was 900 μg/L (96%), which was better than the age-adjusted D-dimer cutoff strategy (NPV 90%). Conclusion: The discriminative ability of D-dimer to diagnose PTE was low. In contrast, D-dimer maintains a high negative predictive value to rule out PTE, which is higher than the value classically described in non-COVID patients.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/sangre , Productos de Degradación de Fibrina-Fibrinógeno/análisis , COVID-19/complicaciones , Embolia Pulmonar/diagnóstico por imagen , Biomarcadores/análisis , Valor Predictivo de las Pruebas , Curva ROC , Sensibilidad y Especificidad , Angiografía por Tomografía ComputarizadaRESUMEN
BACKGROUND: Since the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) pandemic, there have been many reports of increased incidence of venous thromboembolism and arterial events as a complication. OBJECTIVE: To determine the incidence of symptomatic thrombotic events (TEs) in patients hospitalized for SARS-CoV2 disease (coronavirus 19 [Covid-19]). METHODS: A retrospective single-center cohort study with adult patients with a positive reverse transcriptase-polymerase chain reaction (rt-PCR) for SARS-CoV2, included from the date of diagnosis of Covid-19 and followed for 90 days or until death. RESULTS: A total of 1621 patients were included in this study. The median age was 73 years (interquartile range25th-75th [IQR] 53-87 years) and 57% (913) were female. Overall mortality was 21.6% (348). The overall incidence of symptomatic TEs within 90 days of diagnosis was 1.8% (30 of 1621) occurring in 28 patients, including an incidence of pulmonary embolism of 0.9% (15, 95% confidence interval [CI] 0.60%-1.6%), deep venous thrombosis of 0.61% (10, 95% CI 0.2%-1%), ischemic stroke of 0.25% (4, 95% CI 0.09%-0.65%), and ischemic arterial events of 0.06% (1, 95% CI 0.008%-0.43%). No acute coronary syndrome events were recorded. The incidence of symptomatic TEs was significantly lower in the general ward than in intensive care units (1.2% vs 5.7%; p < .001). The median time since positive rt-PCR for SARS-CoV2 to symptomatic TE was 22.5 days (IQR 19-43 days). There was no significant difference in the proportion of patients receiving (53.6%) and not receiving thromboprophylaxis (66.5%) and the development of TEs. CONCLUSION: The overall incidence of symptomatic TEs among these patients was lower than the incidence previously reported.
Asunto(s)
Arteriopatías Oclusivas/epidemiología , COVID-19/epidemiología , Embolia Pulmonar/epidemiología , Tromboembolia/epidemiología , Trombosis de la Vena/epidemiología , Anciano , Anciano de 80 o más Años , Argentina/epidemiología , Arteriopatías Oclusivas/sangre , Arteriopatías Oclusivas/diagnóstico , COVID-19/sangre , COVID-19/diagnóstico , Femenino , Humanos , Incidencia , Accidente Cerebrovascular Isquémico/sangre , Accidente Cerebrovascular Isquémico/diagnóstico , Accidente Cerebrovascular Isquémico/epidemiología , Masculino , Persona de Mediana Edad , Admisión del Paciente , Embolia Pulmonar/sangre , Embolia Pulmonar/diagnóstico , Estudios Retrospectivos , Tromboembolia/sangre , Tromboembolia/diagnóstico , Factores de Tiempo , Trombosis de la Vena/sangre , Trombosis de la Vena/diagnósticoRESUMEN
Half of the cases of pulmonary thromboembolism (PTE) are not diagnosed because of its unspecific clinical presentation; in Mexico, autopsy data reveal a similar incidence to that of developed countries. The objective of this work was to know the concordance between the clinical diagnosis of PTE at hospital discharge and its autopsy diagnosis. The method used was a retrospective cohort study of cases with PTE diagnosis who attended from January 2005 to December 2013. Information was obtained from the autopsies registry and clinical charts. From 177,368 hospital discharges, there were 412 (6.74%) with PTE diagnosis. There were 13,559 deaths, with PTE diagnosis in 139 (1%) patients. There were 479 autopsies, and in 66 (14%) of whom PTE diagnosis was documented, the mean age was 55 years (range, 18-89 years). The premortem diagnosis of PTE at discharge was confirmed in 412 cases. Postmortem diagnosis of principal disease was medical in 49 (74%) and medical-surgical in 17 (26%) patients. We found that nine patients had the clinical diagnosis of PTE, unlike the postmortem diagnosis, which was reported in 66 autopsies. The above allows establishing a 1:7 ratio that represents 14%. D-dimer was determined in 11 cases (16%) and was positive in 8 (73%). Thromboprophylaxis was applied in 15 cases (23%). The study of necropsies and identification of discrepancies is needed to improve the diagnostic accuracy and healthcare quality. The evaluation of hemostasis biomarkers besides D-dimer can better describe the pro-thrombotic state, the risk of thrombosis, and its association with morbidity and mortality.
Asunto(s)
Productos de Degradación de Fibrina-Fibrinógeno/análisis , Alta del Paciente , Embolia Pulmonar/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Autopsia , Biomarcadores/sangre , Causas de Muerte , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Embolia Pulmonar/sangre , Embolia Pulmonar/mortalidad , Embolia Pulmonar/patología , Reproducibilidad de los Resultados , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVE: To determine the prevalence of pulmonary thromboembolism (PET) and identify it's risk factors in patients operated on a scheduled basis, in the general surgery service from the High Specialty Medical Unit Hospital de Especialidades de Puebla, of the Mexican Social Security Institute. METHOD: Descriptive, retrospective and cross sectional study of 52 patients' records with PET and pulmonary angiotomography whose indication was respiratory distress; from 2612 operated patients from November 2015 to March 2018, the sampling was not probabilistic. The statistics was descriptive, with measures of central tendency and dispersion. Fisher test, and Rho Spearman were used. RESULTS: There were association between the development of PET and trans-surgical time (p = 0.018), with the D Dimer (p = 0.014), there was correlation between PET and Wells scale (p=0.001) and blood transfusion (p=0.044). Age, gender, body mass index, preoperative diagnosis, thromboprophylaxis, blood transfusion and surgical approach were not risk factors. CONCLUSION: The prevalence of postoperative PET in patients with respiratory distress after surgical procedure is 5.7% and the mortality is 33.3%.
OBJETIVO: Determinar la prevalencia de la tromboembolia pulmonar (TEP) e identificar sus factores de riesgo en los pacientes intervenidos en el servicio de cirugía general de manera programada de la Unidad Médica de Alta Especialidad Hospital de Especialidades de Puebla, del Instituto Mexicano del Seguro Social. MÉTODO: Estudio descriptivo, retrospectivo y transversal de 52 expedientes de pacientes con TEP y angiotomografía pulmonar cuya indicación fue la dificultad respiratoria, de 2612 pacientes operados de noviembre de 2015 a marzo de 2018. El muestreo fue no probabilístico. La estadística fue descriptiva, con medidas de tendencia central y de dispersión. Se utilizó prueba de Fisher para riesgo y Rho de Spearman. RESULTADOS: Hubo asociación entre el desarrollo de TEP y el tiempo transquirúrgico (p = 0.018), y con el dímero D (p = 0.014); hubo correlación entre la TEP y con la escala de Wells (p = 0.001) y con la transfusión de hemoderivados (p = 0.044). La edad, el sexo, el índice de masa corporal, el diagnóstico preoperatorio, la tromboprofilaxis, la transfusión de hemoderivados y el abordaje quirúrgico no fueron factores de riesgo. CONCLUSIÓN: La prevalencia de TEP posquirúrgica en pacientes que cursan con dificultad respiratoria después del procedimiento quirúrgico es del 5.7% y la mortalidad es del 33.3%.
Asunto(s)
Complicaciones Posoperatorias/epidemiología , Embolia Pulmonar/epidemiología , Síndrome de Dificultad Respiratoria/etiología , Abdomen/cirugía , Adulto , Factores de Edad , Anciano , Transfusión Sanguínea/estadística & datos numéricos , Índice de Masa Corporal , Angiografía por Tomografía Computarizada , Estudios Transversales , Femenino , Productos de Degradación de Fibrina-Fibrinógeno , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Pelvis/cirugía , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Prevalencia , Embolia Pulmonar/sangre , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/etiología , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Estadísticas no ParamétricasRESUMEN
BACKGROUND: Mean platelet volume (MPV) is a risk factor for cardiovascular and inflammatory diseases. AIM: To evaluate the association between high MPV and 90-day mortality after an episode of venous thromboembolism (VTE). MATERIAL AND METHODS: Retrospective cohort of 594 patients with a median age of 73 years (58% women) with a first episode VTE, included in an institutional Thromboembolic Disease registry between 2014 and 2015. MPV values were obtained from the automated blood cell count measured at the moment of VTE diagnosis. Volumes ≥ 11 fL were classified as high. All patients were followed for 90 days to assess survival. RESULTS: The main comorbidities were cancer in 221 patients (37%), sepsis in 172 (29%) and coronary artery disease in 107 (18%). Median MPV was 8 fl (8-9), brain natriuretic peptide 2,000 pg/ml (1,025-3,900) and troponin 40 pg/ml (19.5-75). Overall mortality was 20% (121/594) during the 90 days of follow-up. Thirty three deaths occurred within 7 days and 43 within the first month. The loss of patients from follow-up was 5% (28/594) at 90 days. Mortality among patients with high MP was 36% (23/63). The crude mortality hazard ratio (HR) for high MPV was 2.2 (95% confidence intervals (CI) 1.4-3.5). When adjusted for sepsis, oncological disease, heart disease, kidney failure and surgery, the mortality HR of high MPV was 2.4 (CI95% 1.5-3.9) in the VTE group, 2.3 (CI95% 1.5-4.4) in the deep venous thrombosis group, and 2.9 (CI95% 1.6 -5.6) in the pulmonary embolism group. CONCLUSIONS: High MPV is an independent risk factor for mortality following an episode of VTE.
Asunto(s)
Volúmen Plaquetario Medio , Tromboembolia Venosa/mortalidad , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Plaquetas , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Péptido Natriurético Encefálico/sangre , Neoplasias/complicaciones , Fragmentos de Péptidos/sangre , Pronóstico , Embolia Pulmonar/sangre , Embolia Pulmonar/mortalidad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Sepsis/complicaciones , Análisis de Supervivencia , Troponina/sangre , Tromboembolia Venosa/sangre , Tromboembolia Venosa/complicaciones , Trombosis de la Vena/sangre , Trombosis de la Vena/mortalidadRESUMEN
ABSTRACT Background: Mean platelet volume (MPV) is a risk factor for cardiovascular and inflammatory diseases. Aim: To evaluate the association between high MPV and 90-day mortality after an episode of venous thromboembolism (VTE). Material and Methods: Retrospective cohort of 594 patients with a median age of 73 years (58% women) with a first episode VTE, included in an institutional Thromboembolic Disease registry between 2014 and 2015. MPV values were obtained from the automated blood cell count measured at the moment of VTE diagnosis. Volumes ≥ 11 fL were classified as high. All patients were followed for 90 days to assess survival. Results: The main comorbidities were cancer in 221 patients (37%), sepsis in 172 (29%) and coronary artery disease in 107 (18%). Median MPV was 8 fl (8-9), brain natriuretic peptide 2,000 pg/ml (1,025-3,900) and troponin 40 pg/ml (19.5-75). Overall mortality was 20% (121/594) during the 90 days of follow-up. Thirty three deaths occurred within 7 days and 43 within the first month. The loss of patients from follow-up was 5% (28/594) at 90 days. Mortality among patients with high MP was 36% (23/63). The crude mortality hazard ratio (HR) for high MPV was 2.2 (95% confidence intervals (CI) 1.4-3.5). When adjusted for sepsis, oncological disease, heart disease, kidney failure and surgery, the mortality HR of high MPV was 2.4 (CI95% 1.5-3.9) in the VTE group, 2.3 (CI95% 1.5-4.4) in the deep venous thrombosis group, and 2.9 (CI95% 1.6 −5.6) in the pulmonary embolism group. Conclusions: High MPV is an independent risk factor for mortality following an episode of VTE.
Antecedentes: El volumen plaquetario medio (VPM) es un factor de riesgo de complicaciones cardiovasculares y enfermedades inflamatorias. Objetivo: Evaluar la asociación entre VPM alto y la mortalidad a los 90 días después de un episodio de tromboembolismo venoso (ETV). Material y Métodos: Cohorte retrospectiva de 594 pacientes adultos con una edad media de 73 años (58% mujeres) con un primer episodio de ETV incluidos en un registro de enfermedad tromboembólica institucional entre 2014 y 2015. Se obtuvieron valores de VPM desde el hemograma tomado en el momento del diagnóstico de ETV y un volumen ≥ 11 fL fue clasificado como alto. Todos los pacientes fueron seguidos durante 90 días para determinar sobrevida. Resultados: Las comorbilidades fueron cáncer en 221 pacientes (37%), sepsis en 172 (29%) y enfermedad coronaria en 107 (18%). La mediana de VPM fue 8 fl (89), el péptido natriurético cerebral fue de 2.000 pg/ml (1.025-3.900) y la troponina fue de 40 pg/ml (19,5-75). La mortalidad global a 90 días fue 20% (121/594). Treinta y tres muertes ocurrieron dentro de los 7 días y 43 en el primer mes. La pérdida de seguimiento de pacientes fue de 5% (28/594) a los 90 días. La mortalidad en el grupo con VPM alto fue 36% (23/63). La razón de riesgo (HR) cruda de la mortalidad para un VPM alto fue de 2,2 (intervalos de confianza (IC) de 95% 1,4-3,5). Cuando se ajustó por sepsis, enfermedad oncológica, enfermedad cardíaca, insuficiencia renal y cirugía, la HR de muerte para un VPM alto fue de 2,4 (IC95% 1,5-3,9) en el grupo de ETV; 2,3 (IC95% 1,5-4,4) en el grupo de trombosis venosa profunda; y 2,9 (CI95% 1,6 −5,6) en el grupo de embolia pulmonar. Conclusiones: Un VPM alto es un factor de riesgo independiente de mortalidad después de un episodio de ETV.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Tromboembolia Venosa/mortalidad , Volúmen Plaquetario Medio , Fragmentos de Péptidos/sangre , Pronóstico , Embolia Pulmonar/mortalidad , Embolia Pulmonar/sangre , Troponina/sangre , Plaquetas , Análisis de Supervivencia , Enfermedad Aguda , Estudios Retrospectivos , Factores de Riesgo , Estudios de Seguimiento , Sepsis/complicaciones , Medición de Riesgo , Trombosis de la Vena/mortalidad , Trombosis de la Vena/sangre , Péptido Natriurético Encefálico/sangre , Tromboembolia Venosa/complicaciones , Tromboembolia Venosa/sangre , Neoplasias/complicacionesRESUMEN
PURPOSE: To investigate the correlation of inhaled nitric oxide (NO) on plasma levels of cardiac troponin I (cTnI) and von Willebrand factor (vWF), glycoprotein (GP) IIb/IIIa, granule membrane protein 140 (GMP-140) in rabbits with acute massive pulmonary embolism (PE). METHODS: Thirty apanese white rabbits were divided into 3 groups, thrombus were injected in model group (n = 10), NO were inhalated for 24 h after massive PE in NO group (n = 10), saline were injected in control group (n = 10). The concentrations of vWF, GP IIb/IIIa, GMP-140 and cTnI were tested at 4, 8, 12, 16, 20, and 24 h, Correlation analyses were conducted between cTnI and vWF, GP IIb/IIIa, and GMP-140 by Pearson's correlation. RESULTS: The concentration of cTnI and vWF, GP IIb/IIIa, and GMP-140 was increased in the model group, compared to control group. In the inhaled group, the concentrations of cTnI, vWF, GP IIb/IIIa, and GMP-140 were reduced compared to model group. There was a positive correlation between cTnI and vWF, GP IIb/IIIa, and GMP-140. CONCLUSION: Inhaled nitric oxide can lead to a decrease in levels of cardiac troponin I, von Willebrand factor, glycoprotein, and granule membrane protein 140, after an established myocardial damage, provoked by acute massive pulmonary embolism.
Asunto(s)
Óxido Nítrico/administración & dosificación , Selectina-P/sangre , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria/análisis , Embolia Pulmonar/sangre , Embolia Pulmonar/tratamiento farmacológico , Troponina I/sangre , Factor de von Willebrand/análisis , Administración por Inhalación , Animales , Modelos Animales de Enfermedad , Ventrículos Cardíacos/patología , Miocardio/patología , Selectina-P/efectos de los fármacos , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria/efectos de los fármacos , Embolia Pulmonar/patología , Conejos , Valores de Referencia , Reproducibilidad de los Resultados , Factores de Tiempo , Resultado del Tratamiento , Troponina I/efectos de los fármacos , Microtomografía por Rayos X , Factor de von Willebrand/efectos de los fármacosRESUMEN
PURPOSE: To investigate changes in the plasma concentrations of cardiac troponin I (CTnI), thromboxane A2 (TXA2), prostaglandin I2 (PGI2) and endothelin-1 (ET-1) in rabbits with massive pulmonary embolism (AMPE) and the impact of nitric oxide inhalation (NOI) on these indices. METHODS: A total of 30 Japanese rabbits were used to construct an MPE model and were divided into 3 groups equally (n=10), including an EXP group (undergoing modeling alone), an NOI group (receiving NOI 2 h post-modeling) and a CON group (receiving intravenous physiological saline). RESULTS: In the model group, plasma concentration of CTnI peaked at 16 h following modeling (0.46±0.10 µg/ml) and significantly decreased following NOI. Plasma levels of TXB2, PGI2 and ET-1 peaked at 12, 16 and 8 h following modeling, respectively, and significantly decreased at different time points (0, 2, 4, 8, 12, 16, 20 and 24 h) following NOI. A significant correlation was observed between the peak plasma CTnI concentration and peak TXB2, 6-keto prostaglandin F1α and ET-1 concentrations in the model and NOI groups. CONCLUSION: Increases in plasma TXA2, PGI2 and ET-1 levels causes myocardial damage in a rabbit model of AMPE; however, NOI effectively down regulates the plasma concentration of these molecules to produce a myocardial-protective effect.
Asunto(s)
Broncodilatadores/farmacología , Endotelina-1/sangre , Epoprostenol/sangre , Óxido Nítrico/farmacología , Embolia Pulmonar/sangre , Embolia Pulmonar/tratamiento farmacológico , Tromboxano A2/sangre , Troponina I/sangre , Enfermedad Aguda , Administración por Inhalación , Animales , Regulación hacia Abajo , Ensayo de Inmunoadsorción Enzimática , Femenino , Masculino , Embolia Pulmonar/patología , Conejos , Distribución Aleatoria , Valores de Referencia , Reproducibilidad de los Resultados , Factores de Tiempo , Resultado del TratamientoRESUMEN
Abstract Purpose: To investigate the correlation of inhaled nitric oxide (NO) on plasma levels of cardiac troponin I (cTnI) and von Willebrand factor (vWF), glycoprotein (GP) IIb/IIIa, granule membrane protein 140 (GMP-140) in rabbits with acute massive pulmonary embolism (PE). Methods: Thirty apanese white rabbits were divided into 3 groups, thrombus were injected in model group (n = 10), NO were inhalated for 24 h after massive PE in NO group (n = 10), saline were injected in control group (n = 10). The concentrations of vWF, GP IIb/IIIa, GMP-140 and cTnI were tested at 4, 8, 12, 16, 20, and 24 h, Correlation analyses were conducted between cTnI and vWF, GP IIb/IIIa, and GMP-140 by Pearson's correlation. Results: The concentration of cTnI and vWF, GP IIb/IIIa, and GMP-140 was increased in the model group, compared to control group. In the inhaled group, the concentrations of cTnI, vWF, GP IIb/IIIa, and GMP-140 were reduced compared to model group. There was a positive correlation between cTnI and vWF, GP IIb/IIIa, and GMP-140. Conclusion: Inhaled nitric oxide can lead to a decrease in levels of cardiac troponin I, von Willebrand factor, glycoprotein, and granule membrane protein 140, after an established myocardial damage, provoked by acute massive pulmonary embolism.
Asunto(s)
Animales , Conejos , Embolia Pulmonar/sangre , Factor de von Willebrand/análisis , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria/análisis , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria/efectos de los fármacos , Selectina-P/sangre , Troponina I/sangre , Óxido Nítrico/administración & dosificación , Embolia Pulmonar/patología , Embolia Pulmonar/tratamiento farmacológico , Valores de Referencia , Factores de Tiempo , Administración por Inhalación , Factor de von Willebrand/efectos de los fármacos , Reproducibilidad de los Resultados , Resultado del Tratamiento , Selectina-P/efectos de los fármacos , Troponina I/efectos de los fármacos , Modelos Animales de Enfermedad , Microtomografía por Rayos X , Ventrículos Cardíacos/patología , Miocardio/patologíaRESUMEN
Abstract Purpose: To investigate changes in the plasma concentrations of cardiac troponin I (CTnI), thromboxane A2 (TXA2), prostaglandin I2 (PGI2) and endothelin-1 (ET-1) in rabbits with massive pulmonary embolism (AMPE) and the impact of nitric oxide inhalation (NOI) on these indices. Methods: A total of 30 Japanese rabbits were used to construct an MPE model and were divided into 3 groups equally (n=10), including an EXP group (undergoing modeling alone), an NOI group (receiving NOI 2 h post-modeling) and a CON group (receiving intravenous physiological saline). Results: In the model group, plasma concentration of CTnI peaked at 16 h following modeling (0.46±0.10 µg/ml) and significantly decreased following NOI. Plasma levels of TXB2, PGI2 and ET-1 peaked at 12, 16 and 8 h following modeling, respectively, and significantly decreased at different time points (0, 2, 4, 8, 12, 16, 20 and 24 h) following NOI. A significant correlation was observed between the peak plasma CTnI concentration and peak TXB2, 6-keto prostaglandin F1α and ET-1 concentrations in the model and NOI groups. Conclusion: Increases in plasma TXA2, PGI2 and ET-1 levels causes myocardial damage in a rabbit model of AMPE; however, NOI effectively down regulates the plasma concentration of these molecules to produce a myocardial-protective effect.
Asunto(s)
Animales , Masculino , Femenino , Conejos , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/sangre , Tromboxano A2/sangre , Broncodilatadores/farmacología , Epoprostenol/sangre , Endotelina-1/sangre , Troponina I/sangre , Óxido Nítrico/farmacología , Embolia Pulmonar/patología , Valores de Referencia , Factores de Tiempo , Administración por Inhalación , Ensayo de Inmunoadsorción Enzimática , Distribución Aleatoria , Regulación hacia Abajo , Enfermedad Aguda , Reproducibilidad de los Resultados , Resultado del TratamientoRESUMEN
BACKGROUND/OBJECTIVES: Hepatitis C virus (HCV) infection is one of the leading causes of cirrhosis. As a result of chronic inflammatory response to the virus, HCV-infected patients may be at a higher risk of venous thromboembolism (VTE). However, the data on this association is unclear. This systematic review and meta-analysis was conducted with the aims to summarize all available evidence. MATERIAL AND METHODS: A literature search was performed using MEDLINE and EMBASE from inception to April 2016. Studies that reported relative risks, odd ratios, or hazard ratios comparing the risk of VTE among HCV-infected patients vs. subjects without HCV infection were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. RESULTS: Three studies met our eligibility criteria and were included in analysis. The pooled RR of VTE in HCV-infected patients vs. subjects without HCV infection was 1.38 (95% CI, 1.08-1.77, I2 = 40%). Subgroup analysis showed that risk was increased for both pulmonary embolism (PE) and deep venous thrombosis (DVT) even though without adequate power to demonstrate statistical significance (Pooled RR of 1.34, 95% CI, 0.67-2.66 for PE and pooled RR 1.45, 95% CI, 0.93-2.77 for DVT). CONCLUSION: Our study demonstrated a significantly increased risk of VTE among HCV-infected patients. Further studies are required to clarify how this risk should be addressed in clinical practice.
Asunto(s)
Coagulación Sanguínea , Hepatitis C/epidemiología , Embolia Pulmonar/epidemiología , Tromboembolia Venosa/epidemiología , Trombosis de la Vena/epidemiología , Distribución de Chi-Cuadrado , Femenino , Hepacivirus/patogenicidad , Hepatitis C/sangre , Hepatitis C/diagnóstico , Hepatitis C/virología , Interacciones Huésped-Patógeno , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Embolia Pulmonar/sangre , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/virología , Medición de Riesgo , Factores de Riesgo , Tromboembolia Venosa/sangre , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/virología , Trombosis de la Vena/sangre , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/virologíaRESUMEN
INTRODUCTION: Great ventilation to carbon dioxide output (ΔVËE/ΔVËCO2) and reduced end-tidal partial pressures for CO2 (PetCO2) during incremental exercise are hallmarks of chronic thromboembolic pulmonary hypertension (CTEPH) and idiopathic pulmonary arterial hypertension (IPAH). However, CTEPH is more likely to involve proximal arteries, which may lead to poorer right ventricle-pulmonary vascular coupling and worse gas exchange abnormalities. Therefore, abnormal PetCO2 profiles during exercise may be more prominent in patients with CTEPH and could be helpful to indicate disease severity. METHODS: Seventy patients with CTEPH and 34 with IPAH underwent right heart catheterization and cardiopulmonary exercise testing. According to PetCO2 pattern during exercise, patients were classified as having an increase or stabilization in PetCO2 up to the gas exchange threshold (GET), an abrupt decrease in the rest-exercise transition or a progressive and slow decrease throughout exercise. A subgroup of patients with CTEPH underwent a constant work rate exercise test to obtain arterial blood samples during steady-state exercise. RESULTS: Multivariate logistic regression analyses showed that progressive decreases in PetCO2 and SpO2 were better discriminative parameters than ΔVËE/ΔVËCO2 to distinguish CTEPH from IPAH. This pattern of PetCO2 was associated with worse functional impairment and greater reduction in PaCO2 during exercise. CONCLUSION: Compared to patients with IPAH, patients with CTEPH present more impaired gas exchange during exercise, and PetCO2 abnormalities may be used to identify more clinically and hemodynamically severe cases.
Asunto(s)
Dióxido de Carbono/sangre , Ejercicio Físico/fisiología , Hipertensión Pulmonar/diagnóstico por imagen , Embolia Pulmonar/diagnóstico por imagen , Intercambio Gaseoso Pulmonar/fisiología , Adulto , Análisis de los Gases de la Sangre/métodos , Cateterismo Cardíaco/métodos , Enfermedad Crónica , Prueba de Esfuerzo/métodos , Hipertensión Pulmonar Primaria Familiar/fisiopatología , Femenino , Humanos , Hipertensión Pulmonar/sangre , Hipertensión Pulmonar/fisiopatología , Masculino , Persona de Mediana Edad , Presión Parcial , Embolia Pulmonar/sangre , Embolia Pulmonar/fisiopatología , Pruebas de Función Respiratoria/métodos , Índice de Severidad de la Enfermedad , Volumen de Ventilación Pulmonar , Tomografía Computarizada por Rayos X/métodos , Prueba de Paso/métodosAsunto(s)
Péptido Natriurético Encefálico/sangre , Embolia Pulmonar/sangre , Embolia Pulmonar/complicaciones , Disfunción Ventricular Derecha/sangre , Disfunción Ventricular Derecha/complicaciones , Enfermedad Aguda , Anciano de 80 o más Años , Ecocardiografía , Femenino , Humanos , Medición de Riesgo , Factores de Tiempo , Disfunción Ventricular Derecha/diagnóstico por imagenRESUMEN
CONTEXT AND OBJECTIVE: The location of embolism is associated with clinical findings and disease severity in cases of acute pulmonary embolism. The level of gamma-glutamyl transferase increases under oxidative stress-related conditions. In this study, we investigated whether gamma-glutamyl transferase levels could predict the location of pulmonary embolism. DESIGN AND SETTING: Hospital-based cross-sectional study at Cumhuriyet University, Sivas, Turkey. METHODS: 120 patients who were diagnosed with acute pulmonary embolism through computed tomography-assisted pulmonary angiography were evaluated. They were divided into two main groups (proximally and distally located), and subsequently into subgroups according to thrombus localization as follows: first group (thrombus in main pulmonary artery; n = 9); second group (thrombus in main pulmonary artery branches; n = 71); third group (thrombus in pulmonary artery segmental branches; n = 34); and fourth group (thrombus in pulmonary artery subsegmental branches; n = 8). RESULTS: Gamma-glutamyl transferase levels on admission, heart rate, oxygen saturation, right ventricular dilatation/hypokinesia, pulmonary artery systolic pressure and cardiopulmonary resuscitation requirement showed prognostic significance in univariate analysis. The multivariate logistic regression model showed that gamma-glutamyl transferase level on admission (odds ratio, OR = 1.044; 95% confidence interval, CI: 1.011-1.079; P = 0.009) and pulmonary artery systolic pressure (OR = 1.063; 95% CI: 1.005-1.124; P = 0.033) remained independently associated with proximally localized thrombus in pulmonary artery. CONCLUSIONS: The findings revealed a significant association between increased existing embolism load in the pulmonary artery and increased serum gamma-glutamyl transferase levels.
Asunto(s)
Embolia Pulmonar/enzimología , gamma-Glutamiltransferasa/sangre , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Angiografía Coronaria , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Arteria Pulmonar/patología , Embolia Pulmonar/sangre , Embolia Pulmonar/patología , Curva ROC , Valores de Referencia , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Tomografía Computarizada por Rayos XRESUMEN
ABSTRACT CONTEXT AND OBJECTIVE: The location of embolism is associated with clinical findings and disease severity in cases of acute pulmonary embolism. The level of gamma-glutamyl transferase increases under oxidative stress-related conditions. In this study, we investigated whether gamma-glutamyl transferase levels could predict the location of pulmonary embolism. DESIGN AND SETTING: Hospital-based cross-sectional study at Cumhuriyet University, Sivas, Turkey. METHODS : 120 patients who were diagnosed with acute pulmonary embolism through computed tomography-assisted pulmonary angiography were evaluated. They were divided into two main groups (proximally and distally located), and subsequently into subgroups according to thrombus localization as follows: first group (thrombus in main pulmonary artery; n = 9); second group (thrombus in main pulmonary artery branches; n = 71); third group (thrombus in pulmonary artery segmental branches; n = 34); and fourth group (thrombus in pulmonary artery subsegmental branches; n = 8). RESULTS : Gamma-glutamyl transferase levels on admission, heart rate, oxygen saturation, right ventricular dilatation/hypokinesia, pulmonary artery systolic pressure and cardiopulmonary resuscitation requirement showed prognostic significance in univariate analysis. The multivariate logistic regression model showed that gamma-glutamyl transferase level on admission (odds ratio, OR = 1.044; 95% confidence interval, CI: 1.011-1.079; P = 0.009) and pulmonary artery systolic pressure (OR = 1.063; 95% CI: 1.005-1.124; P = 0.033) remained independently associated with proximally localized thrombus in pulmonary artery. CONCLUSIONS : The findings revealed a significant association between increased existing embolism load in the pulmonary artery and increased serum gamma-glutamyl transferase levels.
RESUMO CONTEXTO E OBJETIVO : A localização da embolia está associada com os resultados clínicos e a gravidade da doença do embolismo pulmonar agudo (EPA). O nível de gama-glutamil transferase (GGT) aumenta em condições relacionadas com estresse oxidativo. Investigou-se se os níveis de GGT podem prever a localização do EPA. TIPO DE ESTUDO E LOCAL : Estudo observacional transversal na Universidade Cumhuriyet, Sivas, Turquia. MÉTODOS : Avaliamos 120 pacientes diagnosticados com EPA após a realização de angiografia pulmonar assistida por tomografia computadorizada. Eles foram divididos em dois grupos principais (localização proximal e distal) e depois em subgrupos de acordo com a localização do trombo da seguinte forma: primeiro grupo (trombo na artéria pulmonar [AP] principal, n = 9); segundo (trombo no ramo da AP principal; n = 71); terceiro grupo (trombo na segmentar da AP; n = 34); quarto grupo (trombo na subsegmentar da AP; n = 8). RESULTADOS : Na análise univariada, os níveis de GGT tiveram significado prognóstico em relação à admissão, pulsação arterial, saturação de oxigênio, dilatação do ventrículo direito/hipocinesia, pressão sistólica da artéria pulmonar (PSAP) e necessidade de ressuscitação cardiopulmonar. O modelo de regressão logística multivariada demonstrou que o nível de GGT na admissão (razão de possibilidades, OR: 1,044; 95% intervalo de confiança, CI: 1,011-1,079; P = 0,009) e PSAP (OR: 1,063, 95% CI: 1,005-1,124; P = 0,033) permaneceram independentemente associados com trombo localizado proximalmente na AP. CONCLUSÕES : Os resultados demonstraram associação significativa entre aumento da carga existente de embolia da AP e aumento dos níveis séricos da GGT.
Asunto(s)
Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Embolia Pulmonar/enzimología , gamma-Glutamiltransferasa/sangre , Enfermedad Aguda , Biomarcadores/sangre , Angiografía Coronaria , Estudios Transversales , Pronóstico , Arteria Pulmonar/patología , Embolia Pulmonar/sangre , Embolia Pulmonar/patología , Curva ROC , Valores de Referencia , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Tomografía Computarizada por Rayos XRESUMEN
AIMS: The pulmonary vasodilation induced by adrenomedullin may be beneficial in the acute pulmonary embolism (APE) setting. This study examined effects of adrenomedullin in sheep with microsphere-induced APE. MAIN METHODS: Twenty four anesthetized, mechanically ventilated sheep were randomly assigned into 3 groups (n=8 per group): animals not subjected to any intervention (Sham), animals with APE induced by microspheres (500 mg, intravenously) treated 30 min later by intravenous physiological saline (Emb group) or intravenous adrenomedullin (50 ng/kg/min) during 30 min (Emb+Adm group). Plasma concentrations of cyclic adenosine (cAMP) and guanosine monophosphate (cGMP) were determined by enzyme immunoassay. KEY FINDINGS: Variables did not change over time in sham animals. In both embolized groups, microsphere injection significantly (P<0.05) increased pulmonary vascular resistance index (PVRI) and mean pulmonary artery pressure (MPAP) from baseline by 181% and 111-142%, respectively (% change in mean values). Adrenomedullin significantly decreased PVRI (18%-25%) and significantly increased cardiac index (22%-25%) from values recorded 30 min after APE (E30), without modifying MPAP. Adrenomedullin decreased mean arterial pressure (18%-24%) and systemic vascular resistance index (32%-40%). Embolization significantly increased arterial-to-end tidal CO2 gradient, alveolar-to-arterial O2 gradient, and pulmonary shunt fraction from baseline, but these variables were unaffected by adrenomedullin. While adrenomedullin significantly increased plasma cAMP, cGMP levels were unaltered. SIGNIFICANCE: Adrenomedullin induces systemic and pulmonary vasodilation, possibly via a cAMP mediated mechanism, without modifying the gas exchange impairment associated with APE. The pulmonary anti-hypertensive effect of adrenomedullin may be offset by increases in cardiac index.
Asunto(s)
Adrenomedulina/uso terapéutico , Hipertensión Pulmonar/tratamiento farmacológico , Pulmón/efectos de los fármacos , Embolia Pulmonar/tratamiento farmacológico , Vasodilatación/efectos de los fármacos , Vasodilatadores/uso terapéutico , Enfermedad Aguda , Animales , AMP Cíclico/sangre , GMP Cíclico/sangre , Modelos Animales de Enfermedad , Hipertensión Pulmonar/sangre , Hipertensión Pulmonar/complicaciones , Hipertensión Pulmonar/fisiopatología , Pulmón/irrigación sanguínea , Pulmón/fisiopatología , Masculino , Embolia Pulmonar/sangre , Embolia Pulmonar/complicaciones , Embolia Pulmonar/fisiopatología , OvinosRESUMEN
Cardiovascular diseases are the main causes of mortality and morbidity in Brazil. Their primary and secondary preventions are a priority for the health system and require multiple approaches for increased effectiveness. Biomarkers are tools used to identify with greater accuracy high-risk individuals, establish a faster diagnosis, guide treatment, and determine prognosis. This review aims to highlight the importance of biomarkers in clinical cardiology practice and raise relevant points regarding their application and perspectives for the next few years. This document was divided into two parts. This second part addresses the application of biomarkers in coronary heart disease, valvular diseases, cardio-oncology, pulmonary embolism, and cardiorenal syndrome.
Asunto(s)
Biomarcadores , Enfermedad Coronaria/diagnóstico , Enfermedades de las Válvulas Cardíacas/diagnóstico , Proteína C-Reactiva/análisis , Técnicas de Diagnóstico Cardiovascular , Humanos , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Embolia Pulmonar/sangre , Factores de Riesgo , Troponina/sangreRESUMEN
OBJECTIVE: Pulmonary embolisms occur as a wide spectrum ranging from clinically asymptomatic thrombi to massive thrombi that lead to cardiogenic shock. The purpose of this study was to determine the associations of thrombus localization with risk factors, accompanying disorders, D-dimer levels and the red blood cell distribution width in patients with pulmonary embolism. MATERIAL AND METHODS: In 148 patients diagnosed with pulmonary embolism, the presence and anatomical localization of the thrombus were assessed via computed tomographic pulmonary angiography. The accompanying disorders, risk factors, serum D-dimer levels, and red blood cell distribution width of the patients were retrospectively evaluated. ClinicalTrials.gov: NCT02388841. RESULTS: The mean age of the patients was 54±16.0 years, and 48 patients were ≥65 years of age. The most frequent accompanying disorders were chronic obstructive pulmonary disease (22%) and malignancy (10.1%), and the most frequent risk factors were recent operation (14.1%) and immobilization (18.2%). Thrombi were most frequently observed in the right pulmonary artery (37.8%). In 31% of the patients, the thrombus was localized to the main pulmonary arteries. Immobile patients exhibited a higher proportion of thrombi in the main pulmonary arteries than mobile patients. The mean D-dimer level and the mean red blood cell distribution width in the patients with thrombi in the main pulmonary arteries were higher than those in the patients with thrombi in more distal pulmonary arterial branches. CONCLUSION: Significant associations of proximally localized thrombi with immobilization, the D-dimer levels, and the red blood cell distribution width were observed.
Asunto(s)
Índices de Eritrocitos , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Embolia Pulmonar/sangre , Trombosis/sangre , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Angiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arteria Pulmonar/diagnóstico por imagen , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/patología , Estudios Retrospectivos , Factores de Riesgo , Trombosis/diagnóstico por imagen , Trombosis/patología , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
OBJECTIVE: Pulmonary embolisms occur as a wide spectrum ranging from clinically asymptomatic thrombi to massive thrombi that lead to cardiogenic shock. The purpose of this study was to determine the associations of thrombus localization with risk factors, accompanying disorders, D-dimer levels and the red blood cell distribution width in patients with pulmonary embolism. MATERIAL AND METHODS: In 148 patients diagnosed with pulmonary embolism, the presence and anatomical localization of the thrombus were assessed via computed tomographic pulmonary angiography. The accompanying disorders, risk factors, serum D-dimer levels, and red blood cell distribution width of the patients were retrospectively evaluated. ClinicalTrials.gov: NCT02388841. RESULTS: The mean age of the patients was 54±16.0 years, and 48 patients were ≥65 years of age. The most frequent accompanying disorders were chronic obstructive pulmonary disease (22%) and malignancy (10.1%), and the most frequent risk factors were recent operation (14.1%) and immobilization (18.2%). Thrombi were most frequently observed in the right pulmonary artery (37.8%). In 31% of the patients, the thrombus was localized to the main pulmonary arteries. Immobile patients exhibited a higher proportion of thrombi in the main pulmonary arteries than mobile patients. The mean D-dimer level and the mean red blood cell distribution width in the patients with thrombi in the main pulmonary arteries were higher than those in the patients with thrombi in more distal pulmonary arterial branches. CONCLUSION: Significant associations of proximally localized thrombi with immobilization, the D-dimer levels, and the red blood cell distribution width were observed. .
Asunto(s)
Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Índices de Eritrocitos , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Embolia Pulmonar/sangre , Trombosis/sangre , Angiografía , Arteria Pulmonar , Embolia Pulmonar/patología , Embolia Pulmonar , Estudios Retrospectivos , Factores de Riesgo , Tomografía Computarizada por Rayos X , Trombosis/patología , TrombosisRESUMEN
We present the case of a 34-year-old woman with a history of antiphospholipid syndrome with triple positivity for antiphospholipid antibodies, who had multiple thrombotic events, predominantly pulmonary embolic events, despite treatment with enoxaparin. She is currently on warfarin, with which she has been adequately controlled most of the time, presenting with only one haemorrhagic event consisting of haematuria and prolonged international normalised ratio (INR) without bleeding. This kind of patient represents a challenge for clinicians, particularly due to INR therapeutic targets, which should be higher than recommended in other patients due to the lupus anticoagulant positivity.