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Expert Review of Respiratory Medicine 2023Given the heterogeneity of predisposing factors associated with pulmonary infarction (PI) and the lack of clinically relevant outcomes among patients with acute...
BACKGROUND
Given the heterogeneity of predisposing factors associated with pulmonary infarction (PI) and the lack of clinically relevant outcomes among patients with acute pulmonary embolism (PE) complicated by PI, further investigation is required.
METHODS
Retrospective study of patients with central PE in an 11-year period. Data were stratified according to the diagnosis of PI. Multivariable logistic regression analysis was used to analyze factors associated with PI development and determine if PI was associated with severe hypoxemic respiratory failure and mechanical ventilation use.
RESULTS
Of 645 patients with central PE, 24% ( = 156) had PI. After adjusting for demographics, comorbidities, and clinical features on admission, only age (OR 0.98, CI 0.96-0.99; = 0.008) was independently associated with PI. Regarding outcomes, 35% ( = 55) had severe hypoxemic respiratory failure, and 19% ( = 29) required mechanical ventilation. After adjusting for demographics, PE severity, and right ventricular dysfunction, PI was independently associated with severe hypoxemic respiratory failure (OR 1.78; CI 1.18-2.69, = 0.005) and mechanical ventilation (OR 1.92; CI 1.14-3.22, = 0.013).
CONCLUSIONS
Aging is a protective factor against PI. In acute central PE, subjects with PI had higher odds of developing severe hypoxemic respiratory failure and requiring mechanical ventilation.
Topics: Humans; Retrospective Studies; Pulmonary Infarction; Respiratory Insufficiency; Pulmonary Embolism; Respiration, Artificial; Acute Disease
PubMed: 37750314
DOI: 10.1080/17476348.2023.2263359 -
Journal of the American College of... Nov 2020
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Pandemics; Pneumonia, Viral; Pulmonary Embolism; Registries; SARS-CoV-2; Thromboembolism
PubMed: 33121713
DOI: 10.1016/j.jacc.2020.09.543 -
Comprehensive Physiology Jan 2023Lung transplant is a treatment option for patients with end-stage lung diseases; however, survival outcomes continue to be inferior when compared to other solid organs.... (Review)
Review
Lung transplant is a treatment option for patients with end-stage lung diseases; however, survival outcomes continue to be inferior when compared to other solid organs. We review the several anatomic and physiologic changes that result from lung transplantation surgery, and their role in the pathophysiology of common complications encountered by lung recipients. The loss of bronchial circulation into the allograft after transplant surgery results in ischemia-related changes in the bronchial artery territory of the allograft. We discuss the role of bronchopulmonary anastomosis in blood circulation in the allograft posttransplant. We review commonly encountered complications related to loss of bronchial circulation such as allograft airway ischemia, necrosis, anastomotic dehiscence, mucociliary dysfunction, and bronchial stenosis. Loss of dual circulation to the lung also increases the risk of pulmonary infarction with acute pulmonary embolism. The loss of lymphatic drainage during transplant surgery also impairs the management of allograft interstitial fluid, resulting in pulmonary edema and early pleural effusion. We discuss the role of lymphatic drainage in primary graft dysfunction. Besides, we review the association of late posttransplant pleural effusion with complications such as acute rejection. We then review the impact of loss of afferent and efferent innervation from the allograft on control of breathing, as well as lung protective reflexes. We conclude with discussion about pulmonary function testing, allograft monitoring with spirometry, and classification of chronic lung allograft dysfunction phenotypes based on total lung capacity measurements. We also review factors limiting physical exercise capacity after lung transplantation, especially impairment of muscle metabolism. © 2023 American Physiological Society. Compr Physiol 13:4269-4293, 2023.
Topics: Humans; Lung; Lung Transplantation; Bronchial Arteries; Ischemia; Pleural Effusion
PubMed: 36715279
DOI: 10.1002/cphy.c220008 -
Thrombosis Research Jun 2023Pulmonary infarction (PI) is relatively common in pulmonary embolism (PE). The association between PI and persistent symptoms or adverse events is largely unknown.
BACKGROUND
Pulmonary infarction (PI) is relatively common in pulmonary embolism (PE). The association between PI and persistent symptoms or adverse events is largely unknown.
AIM
To evaluate the predictive value of radiological PI signs at acute PE diagnosis on 3-month outcomes.
METHODS
We studied a convenience cohort with computed tomography pulmonary angiography (CTPA)-confirmed PE for whom extensive 3-month follow-up data were available. The CTPAs were re-evaluated for signs of suspected PI. Associations with presenting symptoms, adverse events (recurrent thrombosis, PE-related readmission and mortality) and self-reported persistent symptoms (dyspnea, pain and post-PE functional impairment) at 3-month follow-up were investigated using univariate Cox regression analysis.
RESULTS
At re-evaluation of the CTPAs, 57 of 99 patients (58 %) had suspected PI, comprising a median of 1 % (IQR 1-3) of total lung parenchyma. Patients with suspected PI more often presented with hemoptysis (11 % vs. 0 %) and pleural pain (OR 2.7, 95%CI 1.2-6.2), and with more proximal PE on CTPA (OR 1.6, 95%CI 1.1-2.4) than patients without suspected PI. There was no association with adverse events, persistent dyspnea or pain at 3-month follow-up, but signs of PI predicted more functional impairment (OR 3.03, 95%CI 1.01-9.13). Sensitivity analysis with the largest infarctions (upper tertile of infarction volume) yielded similar results.
CONCLUSIONS
PE patients radiologically suspected of PI had a different clinical presentation than patients without those signs and reported more functional limitations after 3 months of follow-up, a finding that could guide patient counselling.
Topics: Humans; Pulmonary Infarction; Computed Tomography Angiography; Pulmonary Embolism; Pulmonary Artery; Dyspnea
PubMed: 37121011
DOI: 10.1016/j.thromres.2023.04.005 -
Journal of Clinical Medicine Aug 2022Pulmonary infarction (PI) is a possible consequence of pulmonary embolism (PE). The real incidence of PI could be underestimated considering only non-fatal PE... (Review)
Review
Pulmonary infarction (PI) is a possible consequence of pulmonary embolism (PE). The real incidence of PI could be underestimated considering only non-fatal PE presentation. However, following postmortem examination, the prevalence of PI is considerably higher. This evidence suggests the necessity of proper diagnostic protocol for identifying PI. Unfortunately, PI diagnosis can sometimes be challenging, due to the overlapping of symptoms with other diseases. Nowadays, the diagnosis is mainly based on radiological evaluation, although the combination with emerging imaging techniques such as ultrasound and nuclear scanning might improve the diagnostic algorithm for PI. This review aims to summarize the available data on the prevalence of PI, the main predisposing factors for the development of PI among patients with PE, to resume the possible diagnostic tools, and finally the clinical and prognostic implications.
PubMed: 36013155
DOI: 10.3390/jcm11164916 -
Terapevticheskii Arkhiv Dec 2023The review on the problem of the pulmonary heart pursues two goals: firstly, to restore historical justice and to show the priority studies of doctor Dmitry D. Pletnev... (Review)
Review
The review on the problem of the pulmonary heart pursues two goals: firstly, to restore historical justice and to show the priority studies of doctor Dmitry D. Pletnev on such problems as diagnosis of right ventricular myocardial infarction, clinical characteristics of congestive heart failure of the right ventricle; secondly, to outline the modern concept of the pulmonary heart. The review provides an analysis of the pathogenetic mechanisms of the development of heart failure in the pulmonary heart. Much attention is paid to echo cardiography data and biological markers are emphasized in assessing the function of the right atrium, right ventricle, tricuspid valve regurgitation, pulmonary artery pressure. Prognostically unfavorable signs of the course of the pulmonary heart have been identified, which include a high degree of tricuspid valve regurgitation, the amplitude of movement of the fibrous valve ring (TAPSE) and atrial fibrillation developing with dilation of the right atrium.
Topics: Humans; Tricuspid Valve Insufficiency; Echocardiography; Heart Atria; Heart Failure; Atrial Fibrillation; Heart Ventricles
PubMed: 38158935
DOI: 10.26442/00403660.2023.12.202497 -
European Heart Journal. Quality of Care... Jan 2020
Topics: Aspirin; Denmark; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Myocardial Infarction; Pulmonary Disease, Chronic Obstructive
PubMed: 30980661
DOI: 10.1093/ehjqcco/qcz016 -
The New England Journal of Medicine Nov 2021
Topics: Adult; Computed Tomography Angiography; Female; Humans; Lung; Pulmonary Artery; Pulmonary Embolism; Pulmonary Infarction; Radiography; Recurrence
PubMed: 34714611
DOI: 10.1056/NEJMicm2109756 -
European Respiratory Review : An... Jun 2020COPD is strongly associated with cardiovascular disease, in particular acute myocardial infarction (AMI). Besides shared risk factors, COPD-related factors, such as... (Review)
Review
COPD is strongly associated with cardiovascular disease, in particular acute myocardial infarction (AMI). Besides shared risk factors, COPD-related factors, such as systemic inflammation and hypoxia, underlie the pathophysiological interaction between COPD and AMI. The prevalence of COPD amongst AMI populations ranges from 7% to 30%, which is possibly even an underestimation due to underdiagnoses of COPD in general. Following the acute event, patients with COPD have an increased risk of mortality, heart failure and arrhythmias during follow-up. Adequate risk stratification can be performed using various imaging techniques, evaluating cardiac size and function after AMI. Conventional imaging techniques such as echocardiography and cardiac magnetic resonance imaging have already indicated impaired cardiac function in patients with COPD without known cardiovascular disease. Advanced imaging techniques such as speckle-tracking echocardiography and T1 mapping could provide more insight into cardiac structure and function after AMI and have proven to be of prognostic value. Future research is required to better understand the impact of AMI on patients with COPD in order to provide effective secondary prevention. The present article summarises the current knowledge on the pathophysiologic factors involved in the interaction between COPD and AMI, the prevalence and outcomes of AMI in patients with COPD and the role of imaging in the acute phase and risk stratification after AMI in patients with COPD.
Topics: Humans; Myocardial Infarction; Prognosis; Pulmonary Disease, Chronic Obstructive; Risk Assessment; Risk Factors; Secondary Prevention
PubMed: 32581139
DOI: 10.1183/16000617.0139-2019 -
The New England Journal of Medicine Apr 2023
Topics: Humans; Cardiovascular Diseases; COVID-19; COVID-19 Vaccines; Immunization, Secondary; Myocardial Infarction; Pulmonary Embolism; Stroke; Vaccines, Combined
PubMed: 36988584
DOI: 10.1056/NEJMc2302134