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Kardiologiia Nov 2022Aim To determine the clinical and prognostic significance of subclinical pulmonary congestion, as evaluated by stress ultrasound (stress-US) examination of the... (Observational Study)
Observational Study
Prognostic Value of Subclinical Pulmonary Congestion With Stress Ultrasound of the Lungs in the Development of Heart Failure in Patients With Primary Myocardial Infarction and Percutaneous Coronary Intervention.
Aim To determine the clinical and prognostic significance of subclinical pulmonary congestion, as evaluated by stress ultrasound (stress-US) examination of the lungs, in the development of heart failure (HF) during the postinfarction period after acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI).Material and methods This prospective observational study included 103 patients with no history of HF and with the first AMI and successful PCI. Standard laboratory tests, including the measurement of NT-proBNP, echocardiography, stress-US of the lungs with a 6-min walk test (6MWT), were performed for all patients. Pulmonary congestion was diagnosed with the total number of B lines ≥2 during stress: mild (2-4 B lines), moderate (5-9 B lines), and severe (≥10 В lines). Subclinical pulmonary congestion implied the absence of clinical signs of congestion in the presence of ultrasonic signs of pulmonary congestion (>2 В lines) during stress. The phenomenon of "wet" lung was identified when the total number of B lines was <2 at rest ("dry" lung) and ≥2 after stress. When the total number of B lines was >2 at rest ("wet" lung at rest) and ≥2 after stress, the phenotype was identified as "very wet" lung. The endpoint was hospitalization for HF during 1.5 years.Results The study showed a high incidence of subclinical pulmonary congestion as determined by the results of stress-US test of the lungs, mild (18.4 %), moderate (37.9 %) and severe (42.7 %), and of "wet" and "very wet" lung phenotypes (65 %). The "wet/very wet" lung phenotypes correlated with the body weight index (R=0.236; p=0.016), troponin concentration upon admission and at 6-12 h (R=0.231; p=0019 and R=0.212; p=0.033, respectively), NT-proBNP concentration (R=0.276; p=0.035), Е peak (R=0.241; p=0.019), global longitudinal strain (GLS) (R=-0.208; p=0.034), and left ventricular end-diastolic dimension (R=0.351; p=0.0004). The higher probability of hospitalization for HF during 1.5 years after the discharge from the hospital correlated with a LV EF ≤48 % (OR, 4.04; 95 % CI: 1.49-10.9; р=0.006), a post-stress total number of B lines ≥10 (OR, 3.10; 95 % CI: 1.06-9.52; р=0.038), a pulmonary artery systolic pressure >27 mm Hg (OR, 3.7; 95 % CI: 1.42-9.61; р=0.007).Conclusion Stress-US of the lungs with evaluation of the total number of B lines should be performed for patients after the first AMI and PCI and with no clinical signs of congestion, for stratification of the risk for HF in the postinfarction period.
Topics: Humans; Prognosis; Percutaneous Coronary Intervention; Pulmonary Edema; Heart Failure; Lung; Myocardial Infarction
PubMed: 36521038
DOI: 10.18087/cardio.2022.11.n2234 -
Annals of Thoracic and Cardiovascular... Dec 2021Pulmonary nodules suspected to be cancerous are rarely diagnosed as pulmonary infarction (PI). This study examined the clinical, radiological, and laboratory data in...
PURPOSE
Pulmonary nodules suspected to be cancerous are rarely diagnosed as pulmonary infarction (PI). This study examined the clinical, radiological, and laboratory data in cases diagnosed with PI to determine their potential utility as preoperative diagnostic markers. We also assessed factors affecting the postoperative course.
METHODS
A total of 603 cases of peripheral pulmonary nodules undiagnosed preoperatively were resected at Hokkaido University Hospital from 2012 to 2019. Of these, we reviewed cases with a postoperative diagnosis of PI. We investigated clinical symptoms, preoperative laboratory data, radiological characteristics, and postoperative complications.
RESULTS
Four patients (0.7%) were diagnosed with PI. All patients had a smoking history. One patient received systemic steroid administration, and none had predisposing factors for thrombosis. One case showed chronologically increased nodule size. Three cases showed weak uptake of F-fluorodeoxyglucose. One patient with preoperative high D-dimer levels developed a massive pulmonary embolism (PE) in the postoperative chronic phase and was treated with anticoagulants.
CONCLUSIONS
Preoperative diagnosis of PI is difficult, and we could not exclude lung cancer. However, if a patient diagnosed with PI has a high D-dimer level, we recommend postoperative physical examination for deep venous thrombosis. Prophylactic anticoagulation therapy should be considered to avoid fatal PE.
Topics: Humans; Postoperative Complications; Pulmonary Embolism; Pulmonary Infarction; Treatment Outcome
PubMed: 33994414
DOI: 10.5761/atcs.oa.20-00396 -
Tuberkuloz Ve Toraks Sep 2020Behcet's disease is a chronic inflammatory multi-systemic vasculitis. Recurrent oral and genital aphthous ulcers, uveitis, arthritis, arterial aneurysms, venous...
Behcet's disease is a chronic inflammatory multi-systemic vasculitis. Recurrent oral and genital aphthous ulcers, uveitis, arthritis, arterial aneurysms, venous thrombosis, gastrointestinal system lesions and skin lesions can be seen. Large, medium or small arteries and veins may be involved. While venous lesions cause occlusion, arterial lesions can cause both occlusion and aneurysm. Major forms of pulmonary involvement include pulmonary artery aneurysm, arterial and venous thrombosis, pulmonary infarction, recurrent pneumonia, and pleurisy. In Behcet's disease, pulmonary thromboembolism (PE) is often associated with endothelial damage. Neutrophils play an important role in the pathogenesis of thrombosis. Coagulation components such as fibrinogen, thrombin, factor Xa and factor VIIa activate the inflammatory cascade and induce vascular events. It is important to understand the pathogenesis of vascular events in determining the effective treatment strategy. Here we present a patient with Behcet's disease who was presented with pulmonary embolism and was investigated for the etiology of thrombosis.
Topics: Behcet Syndrome; Humans; Male; Middle Aged; Pulmonary Artery; Pulmonary Embolism; Tomography, X-Ray Computed; Ultrasonography, Doppler; Venous Thrombosis
PubMed: 33295733
DOI: 10.5578/tt.69502 -
The Pan African Medical Journal 2019The diagnosis of pulmonary thromboembolism (PTE) with changes shown by electrocardiography (ECG) is a challenge in the clinical practice due to rare pathognomonic... (Review)
Review
The diagnosis of pulmonary thromboembolism (PTE) with changes shown by electrocardiography (ECG) is a challenge in the clinical practice due to rare pathognomonic findings. We report the case of a 37-year old woman managed in out of hospital sitting for a chest pain. Electrocardiogram was suggestive of antero-septal acute myocardial infarction (AMI). Catheterization revealed non occlusive coronary disease. Transthoracic echocardiography showed an elevated pulmonary and right heart pressures. Computed tomography pulmonary angiography confirmed the diagnosis of bilateral pulmonary embolism. PTE with ECG changes should be considered in the differential diagnosis of AMI, particularly in young patients with chest pain and ST segment elevation suggestive of acute coronary syndrome.
Topics: Adult; Chest Pain; Computed Tomography Angiography; Diagnosis, Differential; Echocardiography; Female; Humans; Myocardial Infarction; Pulmonary Embolism
PubMed: 31692844
DOI: 10.11604/pamj.2019.33.275.18517 -
Journal of the Chinese Medical... Feb 2023Various inhaled bronchodilators have been associated with cardiovascular safety concerns. This study aimed to investigate the long-term impact of chronic obstructive...
BACKGROUND
Various inhaled bronchodilators have been associated with cardiovascular safety concerns. This study aimed to investigate the long-term impact of chronic obstructive pulmonary disease (COPD) and the safety of COPD medications in patients after their first acute myocardial infarction (AMI).
METHODS
This nationwide cohort study was conducted using data from the Taiwan National Health Insurance Research Database. Patients hospitalized between 2000 and 2012 with a primary diagnosis of first AMI were included and divided into three cohorts (AMI, ST-elevation myocardial infarction [STEMI], and non-STEMI [NSTEMI]). Each cohort was propensity score matched (1:1) with patients without COPD. A Cox proportional hazards regression model was used to estimate hazard ratios (HRs) with 95% CIs.
RESULTS
A total of 186 112 patients with AMI were enrolled, and COPD was diagnosed in 13 065 (7%) patients. Kaplan-Meier curves showed that patients with COPD had a higher mortality risk than those without COPD in all cohorts (AMI, STEMI, and NSTEMI). The HR of mortality in AMI, STEMI, and NSTEMI patients with COPD was 1.12 (95% CI, 1.09-1.14), 1.20 (95% CI, 1.14-1.25), and 1.07 (95% CI, 1.04-1.10), respectively. Short-acting inhaled bronchodilators and corticosteroids increased mortality risk in all three cohorts. However, long-acting inhaled bronchodilators reduced mortality risk in patients with AMI (long-acting beta-agonist [LABA]: HR, 0.87; 95% CI, 0.81-0.94; long-acting muscarinic antagonist [LAMA]: HR, 0.82; 95% CI, 0.69-0.96) and NSTEMI (LABA: HR, 0.89; 95% CI, 0.83-0.97; LAMA: HR, 0.80; 95% CI, 0.68-0.96).
CONCLUSION
This study demonstrated that AMI patients with COPD had higher mortality rates than those without COPD. Using inhaled short-acting bronchodilators and corticosteroids reduced survival, whereas long-acting bronchodilators provided survival benefits in AMI and NSTEMI patients. Therefore, appropriate COPD medication for acute AMI is crucial.
Topics: Humans; Cohort Studies; Bronchodilator Agents; Non-ST Elevated Myocardial Infarction; Administration, Inhalation; Drug Therapy, Combination; Pulmonary Disease, Chronic Obstructive; ST Elevation Myocardial Infarction; Adrenal Cortex Hormones
PubMed: 36652566
DOI: 10.1097/JCMA.0000000000000835 -
World Journal of Cardiology Dec 2021Acute myocardial infarction (AMI) with left ventricular (LV) dysfunction patients, the most common cause of cardiogenic shock (CS), have acutely deteriorating... (Review)
Review
Acute myocardial infarction (AMI) with left ventricular (LV) dysfunction patients, the most common cause of cardiogenic shock (CS), have acutely deteriorating hemodynamic status. The frequent use of vasopressor and inotropic pharmacologic interventions along with mechanical circulatory support (MCS) in these patients necessitates invasive hemodynamic monitoring. After the pivotal Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial failed to show a significant improvement in clinical outcomes in shock patients managed with a pulmonary artery catheter (PAC), the use of PAC has become less popular in clinical practice. In this review, we summarize currently available literature to summarize the indications, clinical relevance, and recommendations for use of PAC in the setting of AMI-CS.
PubMed: 35070114
DOI: 10.4330/wjc.v13.i12.720 -
European Journal of Case Reports in... 2022The main ultrasound criterion for diagnosing pulmonary infarction is the presence of triangular/wedge-shaped or rounded, hypoechogenic, homogeneous, pleura-based...
UNLABELLED
The main ultrasound criterion for diagnosing pulmonary infarction is the presence of triangular/wedge-shaped or rounded, hypoechogenic, homogeneous, pleura-based lesions. When used in point-of-care, ultrasonography of several organs can facilitate the diagnosis of pulmonary embolism in a patient presenting with chest pain. We describe a case of chest pain which we thought was due to angina, but point-of-care ultrasonography directed us to a diagnosis of pulmonary embolism.
LEARNING POINTS
Point-of-care ultrasonography can help the clinician make a rapid diagnosis in patients with acute respiratory failure.The main ultrasound criterion for diagnosing pulmonary infarction is the presence of triangular/wedge-shaped or rounded, hypoechogenic, pleura-based lesions.
PubMed: 35402328
DOI: 10.12890/2022_003272 -
Clinical Imaging Dec 2021
Topics: COVID-19; Humans; Lung; Pulmonary Embolism; Pulmonary Infarction; SARS-CoV-2
PubMed: 34332464
DOI: 10.1016/j.clinimag.2021.07.014 -
Turkish Thoracic Journal Jan 2021The purpose of this study was to determine the prognostic role of C-Reactive Protein (CRP) in acute PE.
OBJECTIVE
The purpose of this study was to determine the prognostic role of C-Reactive Protein (CRP) in acute PE.
MATERIAL AND METHODS
Two hundred and twenty patients with acute PE were consecutively enrolled and followed for 30 days after discharge. Serum CRP and NT-proBNP were determined. Right ventricular function was evaluated by transthoracic echocardiography.
RESULTS
There was a significant difference in age, S-PESI, and CRP levels between the early mortality group and without early mortality group. There was statistically no significant difference between the groups with and without early mortality in terms of gender distribution and whether or not they received thrombolytic therapy for DVT. Pulmonary infarct, pleural fluid, or both have no effect on early mortality. There was no correlation between CRP and pro-BNP, right/left ventricular ratio. The serum CRP levels at diagnosis were significantly higher in patients with PE and with pleural effusion and pulmonary infarct than those in PE patients without pleural effusion and pulmonary infarct (4.75±4.91 ng/mL, 9.67±8.02 ng/mL; p<0.0003).
CONCLUSION
High levels of CRP owing to inflammation in pulmonary embolism associated with effusion and infarction reveals why early mortality is significant in this group. CRP may help in the risk stratification of patients with acute PE, especially those with effusion and pulmonary infarction. CRP is an inexpensive and easily applicable biochemical marker, which can be used to predict early mortality.
PubMed: 33646097
DOI: 10.5152/TurkThoracJ.2020.19048 -
BMJ Case Reports Mar 2022Crohn's disease and ulcerative colitis are inflammatory bowel diseases (IBDs) and they primarily involve the intestines and confer an increased risk of thromboembolism...
Crohn's disease and ulcerative colitis are inflammatory bowel diseases (IBDs) and they primarily involve the intestines and confer an increased risk of thromboembolism (TE). Here we report a case of a young man with active ulcerative colitis (UC) who presented with shortness of breath and syncope. He was found on imaging to have an extensive bilateral pulmonary embolism (PE) and right heart strain with associated pulmonary infarctions. The patient was initially managed with a heparin infusion and subsequently transitioned to a direct acting oral anticoagulant (DOAC) with clinical improvement in his symptoms.
Topics: Colitis, Ulcerative; Crohn Disease; Humans; Male; Pulmonary Embolism; Pulmonary Infarction
PubMed: 35264397
DOI: 10.1136/bcr-2022-249428