- Email: [email protected]
How can we predict the prognosis in pulmonary embolism?
How can we predict the prognosis in pulmonary embolism? Omer Uz, Mustafa Aparci, Zafer Isilak, Mehmet Uzun PII: DOI: Reference:
S0735-6757(16)00256-4 doi: 10.1016/j.ajem.2016.03.052 YAJEM 55701
To appear in:
American Journal of Emergency Medicine
Received date: Accepted date:
18 February 2016 17 March 2016
Please cite this article as: Uz Omer, Aparci Mustafa, Isilak Zafer, Uzun Mehmet, How can we predict the prognosis in pulmonary embolism?, American Journal of Emergency Medicine (2016), doi: 10.1016/j.ajem.2016.03.052
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
E-mail: [email protected]
Mustafa APARCI
E-mail:[email protected]
Zafer Isilak
E-mail: [email protected]
Mehmet Uzun
E-mail:[email protected]
RI P
Omer UZ
T
How can we predict the prognosis in pulmonary embolism?
Corresponding author: Omer Uz, MD Department of Cardiology,
MA NU
SC
GATA Haydarpasa Training and Research Hospital, Department of Cardiology, Istanbul/Turkey
Gulhane Military Medical Academy Haydarpasa Training Hospital 34668, Kadikoy, Istanbul/TURKEY
AC
CE
PT
E-mail: [email protected]
Fax : +90-216-348-7880
ED
Tel.: +90-216-542-2020 (3480)
ACCEPTED MANUSCRIPT Dear Editor, We have read the case report of Yoo et al, entitled ' Comparison between systemic vs catheter thrombolysis in patients with pulmonary embolism' with great interest (1). The authors have compared the clinical outcomes (mortality and major bleeding) between
T
systemic thrombolysis (ST) and catheter directed therapy (CDT) in patients with acute
RI P
massive and submassive pulmonary embolism(PE). They have reported that similar clinical outcomes were shown between ST and CDT in patients presented with acute massive or submassive PE.
SC
We would like to share some considerations on this issue. Mortality and morbidity of massive and submassive pulmonary embolism is significantly high. However, prediction of
MA NU
prognosis by means of various clinical variables may allow the clinician to design the treatment algorithm. In the guidelines of acute pulmonary embolism published by ESC in 2014, it was reported that right ventricular functions determined by transthoracic echocardiography and the right ventricle dimensions determined by computerized tomography were the clinical variables that can predict the prognosis accurately. Recent studies support this conclusion (2,3).
ED
It is unfortunate that functions and dimensions of the right ventricle were not presented in this case as the influence of ST and CDT on the improvement of right ventricle
PT
functions may be additional clinical variables that predict the effectiveness of thrombolytic treatment options. Relationship between the treatment options and right ventricle functions
future.
CE
may naturally determine the prognosis of PE and also may guide our preferences in the
Additionally, the presence of a mobile thrombus in the right ventricle is still a
AC
disputable issue for the indication of ST or CDT in acute pulmonary embolism. Since mortality is significantly higher in these cases, these patients should be evaluated and decided for surgical embolectomy. (2). Furthermore transthoracic echocardiography examination provides very signficant clinical inofrmation and shall be performed in almost all the patients to whom thrombolytic therapy was planned.
ACCEPTED MANUSCRIPT
References 1-Yoo J W, Choi H C, Lee S J, Cho Y J, Lee J D, Kim H C. Comparison between systemic
RI P
Emergency Medicine (2016), doi: 10.1016/j.ajem.2016.02.037
T
vs catheter thrombolysis in patients with pulmonary embolism, American Journal of
2-Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur
3-Becattini
C,
Agnelli G,
SC
Heart J 2014;35:3033-69.
Vedovati MC, Pruszczyk P, Casazza F, Grifoni S,
et al.
MA NU
Multidetector computed tomography for acute pulmonary embolism: diagnosis and risk
AC
CE
PT
ED
stratification in a single test. Eur Heart J 2011;32:1657-63.
S0735-6757(16)00256-4 doi: 10.1016/j.ajem.2016.03.052 YAJEM 55701
To appear in:
American Journal of Emergency Medicine
Received date: Accepted date:
18 February 2016 17 March 2016
Please cite this article as: Uz Omer, Aparci Mustafa, Isilak Zafer, Uzun Mehmet, How can we predict the prognosis in pulmonary embolism?, American Journal of Emergency Medicine (2016), doi: 10.1016/j.ajem.2016.03.052
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
E-mail: [email protected]
Mustafa APARCI
E-mail:[email protected]
Zafer Isilak
E-mail: [email protected]
Mehmet Uzun
E-mail:[email protected]
RI P
Omer UZ
T
How can we predict the prognosis in pulmonary embolism?
Corresponding author: Omer Uz, MD Department of Cardiology,
MA NU
SC
GATA Haydarpasa Training and Research Hospital, Department of Cardiology, Istanbul/Turkey
Gulhane Military Medical Academy Haydarpasa Training Hospital 34668, Kadikoy, Istanbul/TURKEY
AC
CE
PT
E-mail: [email protected]
Fax : +90-216-348-7880
ED
Tel.: +90-216-542-2020 (3480)
ACCEPTED MANUSCRIPT Dear Editor, We have read the case report of Yoo et al, entitled ' Comparison between systemic vs catheter thrombolysis in patients with pulmonary embolism' with great interest (1). The authors have compared the clinical outcomes (mortality and major bleeding) between
T
systemic thrombolysis (ST) and catheter directed therapy (CDT) in patients with acute
RI P
massive and submassive pulmonary embolism(PE). They have reported that similar clinical outcomes were shown between ST and CDT in patients presented with acute massive or submassive PE.
SC
We would like to share some considerations on this issue. Mortality and morbidity of massive and submassive pulmonary embolism is significantly high. However, prediction of
MA NU
prognosis by means of various clinical variables may allow the clinician to design the treatment algorithm. In the guidelines of acute pulmonary embolism published by ESC in 2014, it was reported that right ventricular functions determined by transthoracic echocardiography and the right ventricle dimensions determined by computerized tomography were the clinical variables that can predict the prognosis accurately. Recent studies support this conclusion (2,3).
ED
It is unfortunate that functions and dimensions of the right ventricle were not presented in this case as the influence of ST and CDT on the improvement of right ventricle
PT
functions may be additional clinical variables that predict the effectiveness of thrombolytic treatment options. Relationship between the treatment options and right ventricle functions
future.
CE
may naturally determine the prognosis of PE and also may guide our preferences in the
Additionally, the presence of a mobile thrombus in the right ventricle is still a
AC
disputable issue for the indication of ST or CDT in acute pulmonary embolism. Since mortality is significantly higher in these cases, these patients should be evaluated and decided for surgical embolectomy. (2). Furthermore transthoracic echocardiography examination provides very signficant clinical inofrmation and shall be performed in almost all the patients to whom thrombolytic therapy was planned.
ACCEPTED MANUSCRIPT
References 1-Yoo J W, Choi H C, Lee S J, Cho Y J, Lee J D, Kim H C. Comparison between systemic
RI P
Emergency Medicine (2016), doi: 10.1016/j.ajem.2016.02.037
T
vs catheter thrombolysis in patients with pulmonary embolism, American Journal of
2-Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur
3-Becattini
C,
Agnelli G,
SC
Heart J 2014;35:3033-69.
Vedovati MC, Pruszczyk P, Casazza F, Grifoni S,
et al.
MA NU
Multidetector computed tomography for acute pulmonary embolism: diagnosis and risk
AC
CE
PT
ED
stratification in a single test. Eur Heart J 2011;32:1657-63.