Imaging and Biomarkers: The Assesment of Pulmonary Embolism Risk and Early Mortality
<i>Background and Objectives</i>: Pulmonary embolism (PE) incidence has been increasing in the last 10 years. Computed thoracic pulmonary angiography (CTPA) had a major role in PE diagnosis and prognosis. The main purpose of this study was as follows: the prognostic value of a CTPA param...
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2024-09-01
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| author | Alexandru Gratian Naum Irina Jari Liliana Moisii Andra Mara Ursu Paloma Moisii |
| author_facet | Alexandru Gratian Naum Irina Jari Liliana Moisii Andra Mara Ursu Paloma Moisii |
| author_sort | Alexandru Gratian Naum |
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| description | <i>Background and Objectives</i>: Pulmonary embolism (PE) incidence has been increasing in the last 10 years. Computed thoracic pulmonary angiography (CTPA) had a major role in PE diagnosis and prognosis. The main purpose of this study was as follows: the prognostic value of a CTPA parameter, pulmonary artery obstruction index (PAOI), in PE risk assessment and the predictive accuracy of biomarkers, D-dimer and cardiac Troponin T (c-TnT), in 7-day mortality. A second objective of the research was to investigate the relationship between imaging by PAOI and these biomarkers in different etiologies of PE. <i>Materials and Methods</i>: This study comprised 109 patients with PE, hospitalized and treated between February 2021 and August 2022. They had different etiologies of PE: deep vein thrombosis (DVT); persistent atrial fibrillation (AF); chronic obstructive pulmonary disease (COPD) exacerbation; COVID-19; and cancers. The investigations were as follows: clinical examination; D-dimer testing, as a mandatory method for PE suspicion (values ≥500 µg/L were highly suggestive for PE); c-TnT, as a marker of myocardial injury (values ≥14 ng/L were abnormal); CTPA, with right ventricle dysfunction (RVD) signs and PAOI. Treatments were according to PE risk: systemic thrombolysis in high-risk PE; low weight molecular heparins (LWMH) in high-risk PE, after systemic thrombolysis or from the beginning, when systemic thrombolysis was contraindicated; and direct oral anticoagulants (DOAC) in low- and intermediate-risk PE. <i>Results</i>: PAOI had a high predictive accuracy for high-risk PE (area under curve, AUC = 0.993). D-dimer and cTnT had a statistically significant relationship with 7-day mortality for the entire sample, <i>p</i> < 0.001, and for AF, <i>p</i> = 0.0036; COVID-19, <i>p</i> = 0.003; and cancer patients, <i>p</i> = 0.005. PAOI had statistical significance for 7-day mortality only in COVID-19, <i>p</i> = 0.045, and cancer patients, <i>p</i> = 0.038. The relationship PAOI–D-dimer and PAOI–c-TnT had very strong statistical correlation for the entire sample and for DVT, AF, COPD, and COVID-19 subgroups (Rho = 0.815–0.982). <i>Conclusions</i>: PAOI was an important tool for PE risk assessment. D-dimer and c-TnT were valuable predictors for 7-day mortality in PE. PAOI (imaging parameter for PE extent) and D-dimer (biomarker for PE severity) as well as PAOI and c-TnT (biomarker for myocardial injury) were strongly correlated for the entire PE sample and for DVT, AF, COPD, and COVID-19 patients. |
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| spelling | doaj-art-1d05f1fa972e44efa92e42fb29322a622025-08-20T01:55:40ZengMDPI AGMedicina1010-660X1648-91442024-09-01609148910.3390/medicina60091489Imaging and Biomarkers: The Assesment of Pulmonary Embolism Risk and Early MortalityAlexandru Gratian Naum0Irina Jari1Liliana Moisii2Andra Mara Ursu3Paloma Moisii42nd Morphofunctional Sciences Department, Biophysics and Medical Physics, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania2nd Surgical Department, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania2nd Surgical Department, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, RomaniaSt. Spiridon Emergency Hospital, Radiology and Medical Imaging Clinique, 1st Independentei Avenue, 700111 Iasi, Romania1st Medical Department “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania<i>Background and Objectives</i>: Pulmonary embolism (PE) incidence has been increasing in the last 10 years. Computed thoracic pulmonary angiography (CTPA) had a major role in PE diagnosis and prognosis. The main purpose of this study was as follows: the prognostic value of a CTPA parameter, pulmonary artery obstruction index (PAOI), in PE risk assessment and the predictive accuracy of biomarkers, D-dimer and cardiac Troponin T (c-TnT), in 7-day mortality. A second objective of the research was to investigate the relationship between imaging by PAOI and these biomarkers in different etiologies of PE. <i>Materials and Methods</i>: This study comprised 109 patients with PE, hospitalized and treated between February 2021 and August 2022. They had different etiologies of PE: deep vein thrombosis (DVT); persistent atrial fibrillation (AF); chronic obstructive pulmonary disease (COPD) exacerbation; COVID-19; and cancers. The investigations were as follows: clinical examination; D-dimer testing, as a mandatory method for PE suspicion (values ≥500 µg/L were highly suggestive for PE); c-TnT, as a marker of myocardial injury (values ≥14 ng/L were abnormal); CTPA, with right ventricle dysfunction (RVD) signs and PAOI. Treatments were according to PE risk: systemic thrombolysis in high-risk PE; low weight molecular heparins (LWMH) in high-risk PE, after systemic thrombolysis or from the beginning, when systemic thrombolysis was contraindicated; and direct oral anticoagulants (DOAC) in low- and intermediate-risk PE. <i>Results</i>: PAOI had a high predictive accuracy for high-risk PE (area under curve, AUC = 0.993). D-dimer and cTnT had a statistically significant relationship with 7-day mortality for the entire sample, <i>p</i> < 0.001, and for AF, <i>p</i> = 0.0036; COVID-19, <i>p</i> = 0.003; and cancer patients, <i>p</i> = 0.005. PAOI had statistical significance for 7-day mortality only in COVID-19, <i>p</i> = 0.045, and cancer patients, <i>p</i> = 0.038. The relationship PAOI–D-dimer and PAOI–c-TnT had very strong statistical correlation for the entire sample and for DVT, AF, COPD, and COVID-19 subgroups (Rho = 0.815–0.982). <i>Conclusions</i>: PAOI was an important tool for PE risk assessment. D-dimer and c-TnT were valuable predictors for 7-day mortality in PE. PAOI (imaging parameter for PE extent) and D-dimer (biomarker for PE severity) as well as PAOI and c-TnT (biomarker for myocardial injury) were strongly correlated for the entire PE sample and for DVT, AF, COPD, and COVID-19 patients.https://www.mdpi.com/1648-9144/60/9/1489pulmonary embolismpulmonary artery obstruction indexD-dimercardiac troponin T |
| spellingShingle | Alexandru Gratian Naum Irina Jari Liliana Moisii Andra Mara Ursu Paloma Moisii Imaging and Biomarkers: The Assesment of Pulmonary Embolism Risk and Early Mortality Medicina pulmonary embolism pulmonary artery obstruction index D-dimer cardiac troponin T |
| title | Imaging and Biomarkers: The Assesment of Pulmonary Embolism Risk and Early Mortality |
| title_full | Imaging and Biomarkers: The Assesment of Pulmonary Embolism Risk and Early Mortality |
| title_fullStr | Imaging and Biomarkers: The Assesment of Pulmonary Embolism Risk and Early Mortality |
| title_full_unstemmed | Imaging and Biomarkers: The Assesment of Pulmonary Embolism Risk and Early Mortality |
| title_short | Imaging and Biomarkers: The Assesment of Pulmonary Embolism Risk and Early Mortality |
| title_sort | imaging and biomarkers the assesment of pulmonary embolism risk and early mortality |
| topic | pulmonary embolism pulmonary artery obstruction index D-dimer cardiac troponin T |
| url | https://www.mdpi.com/1648-9144/60/9/1489 |
| work_keys_str_mv | AT alexandrugratiannaum imagingandbiomarkerstheassesmentofpulmonaryembolismriskandearlymortality AT irinajari imagingandbiomarkerstheassesmentofpulmonaryembolismriskandearlymortality AT lilianamoisii imagingandbiomarkerstheassesmentofpulmonaryembolismriskandearlymortality AT andramaraursu imagingandbiomarkerstheassesmentofpulmonaryembolismriskandearlymortality AT palomamoisii imagingandbiomarkerstheassesmentofpulmonaryembolismriskandearlymortality |