Recent Advances in Pulmonary Embolism

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (25 January 2023) | Viewed by 30697

Special Issue Editor

1. Department of Cardiology, University Hospital Jean Minjoz, Boulevard Fleming, EA3920, France University of Burgundy Franche-Comté, Besançon, France
2. F-CRIN, INNOVTE network, Saint-Etienne, France
Interests: Pulmonary embolism; interventional cardiology; anticoagulation

Special Issue Information

Dear Colleagues,

Pulmonary embolism (PE) is a major cause of hospitalization, morbidity, and mortality and is responsible for approximately 100,000 deaths each year in the United States. Furthermore, PE incidence continues to rise nationwide and worldwide. The 30-day mortality rate remains high, at about 25% for patients presenting with cardiogenic shock, despite improvements in our understanding of pathophysiology, and innovations in anticoagulation and reperfusion.

This special issue will focus on the most up-to-date knowledge and research about recent advances in the management of pulmonary embolism. We invite contributions in areas including (but not limited to) the following:

  • Management of intermediate-high or high-risk PE, including the use of systemic thrombolysis, catheter-directed pulmonary reperfusion, surgical embolectomy, extracorporeal embolectomy.
  • Bleeding risk assessment and management.
  • Right ventricular function.
  • Home PE treatment of low-risk PE.
  • Long-term PE management including anticoagulation, screening and treatment of complications.
  • Cancer-associated venous thromboembolism.
  • Covid-19-associated venous thromboembolism.

This special issue will highlight the outstanding advances in our understanding of overall PE management. This collection of cutting-edge research and reviews will help clinicians and policy-makers to leverage key aspects to improve PE knowledge.

We look forward to your contributions!

Dr. Romain Chopard
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Pulmonary embolism
  • Early risk stratification
  • Bleeding risk
  • Right ventricle function
  • Management
  • Advanced therapies
  • Cancer-associated venous thromboembolism
  • Covid-19 associated venous thromboembolism
  • Home pulmonary embolism treatment
  • Long term management
  • Long-term treatment
  • Thrombophilia

Published Papers (8 papers)

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Research

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10 pages, 1204 KiB  
Article
Plasma Troponins Identify Patients with Very Low-Risk Acute Pulmonary Embolism
by Bartosz Karolak, Michał Ciurzyński, Marta Skowrońska, Katarzyna Kurnicka, Magdalena Pływaczewska, Aleksandra Furdyna, Katarzyna Perzanowska-Brzeszkiewicz, Barbara Lichodziejewska, Szymon Pacho, Michał Machowski, Piotr Bienias, Małgorzata Wiśniewska, Marek Gołębiowski and Piotr Pruszczyk
J. Clin. Med. 2023, 12(4), 1276; https://doi.org/10.3390/jcm12041276 - 06 Feb 2023
Viewed by 1192
Abstract
Introduction: Although in the non-vitamin K oral anticoagulants (NOAC) era majority of low-risk acute pulmonary embolism (APE) patients can be treated at home, identifying those at very low risk of clinical deterioration may be challenging. We aimed to propose the risk stratification algorithm [...] Read more.
Introduction: Although in the non-vitamin K oral anticoagulants (NOAC) era majority of low-risk acute pulmonary embolism (APE) patients can be treated at home, identifying those at very low risk of clinical deterioration may be challenging. We aimed to propose the risk stratification algorithm in sPESI 0 point APE patients, allowing them to select candidates for safe outpatient treatment. Materials and methods: Post hoc analysis of a prospective study of 1151 normotensive patients with at least segmental APE. In the final analysis, we included 409 sPESI 0 point patients. Cardiac troponin assessment and echocardiographic examination were performed immediately after admission. Right ventricular dysfunction was defined as the right ventricle/left ventricle ratio (RV/LV) > 1.0. The clinical endpoint (CE) included APE-related mortality and/or rescue thrombolysis and/or immediate surgical embolectomy in patients with clinical deterioration. Results: CE occurred in four patients who had higher serum troponin levels than subjects with a favorable clinical course (troponin/ULN: 7.8 (6.4–9.4) vs. 0.2 (0–1.36) p = 0.000). Receiver operating characteristic (ROC) analysis showed that the area under the curve for troponin in the prediction of CE was 0.908 (95% CI 0.831–0.984; p < 0.001). We defined the cut-off value of troponin at >1.7 ULN with 100% PPV for CE. In univariate and multivariate analysis, elevated serum troponin level was associated with an increased risk of CE, whereas RV/LV > 1.0 was not. Conclusions: Solely clinical risk assessment in APE is insufficient, and patients with sPESI 0 points require further assessment based on myocardial damage biomarkers. Patients with troponin levels not exceeding 1.7 ULN constitute the group of “very low risk” with a good prognosis. Full article
(This article belongs to the Special Issue Recent Advances in Pulmonary Embolism)
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13 pages, 985 KiB  
Article
CRB-65 for Risk Stratification and Prediction of Prognosis in Pulmonary Embolism
by Karsten Keller, Volker H. Schmitt, Ingo Sagoschen, Thomas Münzel, Christine Espinola-Klein and Lukas Hobohm
J. Clin. Med. 2023, 12(4), 1264; https://doi.org/10.3390/jcm12041264 - 05 Feb 2023
Cited by 2 | Viewed by 13239
Abstract
Background: Pulmonary embolism (PE) is accompanied by high morbidity and mortality. The search for simple and easily assessable risk stratification scores with favourable effectiveness is still ongoing, and prognostic performance of the CRB-65 score in PE might promising. Methods: The German nationwide inpatient [...] Read more.
Background: Pulmonary embolism (PE) is accompanied by high morbidity and mortality. The search for simple and easily assessable risk stratification scores with favourable effectiveness is still ongoing, and prognostic performance of the CRB-65 score in PE might promising. Methods: The German nationwide inpatient sample was used for this study. All patient cases of patients with PE in Germany 2005–2020 were included and stratified for CRB-65 risk class: low-risk group (CRB-65-score 0 points) vs. high-risk group (CRB-65-score ≥1 points). Results: Overall, 1,373,145 patient cases of patients with PE (76.6% aged ≥65 years, 47.0% females) were included. Among these, 1,051,244 patient cases (76.6%) were classified as high-risk according to CRB-65 score (≥1 points). The majority of high-risk patients according to CRB-65 score were females (55.8%). Additionally, high-risk patients according to CRB-65 score showed an aggravated comorbidity profile with increased Charlson comorbidity index (5.0 [IQR 4.0–7.0] vs. 2.0 [0.0–3.0], p < 0.001). In-hospital case fatality (19.0% vs. 3.4%, p < 0.001) and MACCE (22.4% vs. 5.1%, p < 0.001) occurred distinctly more often in PE patients of the high-risk group according to CRB-65 score (≥1 points) compared to the low-risk group (= 0 points). The CRB-65 high-risk class was independently associated with in-hospital death (OR 5.53 [95%CI 5.40–5.65], p < 0.001) as well as MACCE (OR 4.31 [95%CI 4.23–4.40], p < 0.001). Conclusions: Risk stratification with CRB-65 score was helpful for identifying PE patients being at higher risk of adverse in-hospital events. The high-risk class according to CRB-65 score (≥1 points) was independently associated with a 5.5-fold increased occurrence of in-hospital death. Full article
(This article belongs to the Special Issue Recent Advances in Pulmonary Embolism)
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9 pages, 266 KiB  
Article
Clinical Differences and Outcomes of COVID-19 Associated Pulmonary Thromboembolism in Comparison with Non-COVID-19 Pulmonary Thromboembolism
by Santiago de Cossio, Diana Paredes-Ruiz, Covadonga Gómez-Cuervo, Jesús González-Olmedo, Antonio Lalueza, Yolanda Revilla, Carlos Lumbreras and Carmen Díaz-Pedroche
J. Clin. Med. 2022, 11(20), 6011; https://doi.org/10.3390/jcm11206011 - 12 Oct 2022
Cited by 3 | Viewed by 1250
Abstract
(1) Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been reported to increase the risk of pulmonary thromboembolism (PTE). The aim of this study is to elucidate whether Coronavirus disease COVID-19-associated PTE has a different clinical expression than non-COVID-19 PTE due [...] Read more.
(1) Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been reported to increase the risk of pulmonary thromboembolism (PTE). The aim of this study is to elucidate whether Coronavirus disease COVID-19-associated PTE has a different clinical expression than non-COVID-19 PTE due to a different pathophysiology. (2) Methods: retrospective study of PTE episodes conducted at our hospital between January 2019 and December 2020, comparing the group of COVID-19-associated PTE patients with a control group of non-COVID-19 PTE patients. (3) Results: A total of 229 patients with PTE were registered, 79 of whom had COVID-19. Cancer (15.2% vs. 39.3%; p < 0.001), previous surgery (0% vs. 8%; p = 0.01), previous VTE (2.5% vs. 15.3%; p = 0.003), signs and/or symptoms of deep venous thrombosis (DVT) (7.6% vs. 22.7%; p = 0.004) and syncope (1.3% vs. 8.1%; p = 0.035) were less frequent in the COVID-19 group. Central thrombosis was more frequent in the control group (35.3% vs. 13.9%; p = 0.001). No VTE recurrent episodes were observed in the COVID-19 group, whereas four (2.7%) episodes were recorded for the control group. One-month bleeding rate was higher in the COVID-19 group (10.1% vs. 1.3%; p = 0.004). (4) Conclusion: COVID-19-associated PTE has clinical characteristics that differ from those of PTE without COVID-19, including inferior severity and a lower rate of VTE recurrence. Physicians should be aware of the high risk of bleeding in the first month of COVID-19-associated PTE. Full article
(This article belongs to the Special Issue Recent Advances in Pulmonary Embolism)
13 pages, 990 KiB  
Article
Brain-Derived Neurotrophic Factor Expression in Patients with Acute Pulmonary Embolism Compared to the General Population: Diagnostic and Prognostic Implications
by Mihai Ștefan Cristian Haba, Ionuț Tudorancea, Cosmin Teodor Mihai, Viviana Onofrei, Irina Iuliana Costache, Antoniu Octavian Petriș and Laurențiu Șorodoc
J. Clin. Med. 2022, 11(17), 4948; https://doi.org/10.3390/jcm11174948 - 23 Aug 2022
Viewed by 1403
Abstract
(1) Background: Pulmonary embolism (PE) is a severe condition, representing the third most important cardiovascular cause of death after myocardial infarction and stroke. Despite the use of clinical pre-test probability scores, D-dimer measuring, and computer tomography pulmonary angiography (CTPA), PE diagnosis remains a [...] Read more.
(1) Background: Pulmonary embolism (PE) is a severe condition, representing the third most important cardiovascular cause of death after myocardial infarction and stroke. Despite the use of clinical pre-test probability scores, D-dimer measuring, and computer tomography pulmonary angiography (CTPA), PE diagnosis remains a challenge. Brain-derived neurotrophic factor (BDNF) is the most important member of the neurotrophin family, which has also been shown to be involved in the physiopathology of cardiovascular conditions such as heart failure and myocardial infarction. In this study, we aimed to assess the BDNF expression in patients with acute PE compared to the general population, and to also investigate its diagnostic and prognostic role. (2) Methods: We conducted a single center prospective study, which included 90 patients with PE and 55 healthy volunteers. Clinical and paraclinical parameters, together with plasma levels of BDNF, were evaluated in all patients after admission. (3) Results: The plasma levels of BDNF were significantly lower in the PE patients compared with the control group (403 vs. 644 pg/mL, p < 0.001). ROC analysis revealed an AUC of 0.806 (95% CI 0.738–0.876, p < 0.001) and a cut-off value of 564 pg/mL, which associated a sensitivity of 74.4% and a specificity of 78.2% for PE. Low BDNF levels also correlated with prognostic markers of PE, such as PESI score (p = 0.023), NT-proBNP (p < 0.01), right ventricular diameter (p = 0.029), and tricuspid annular plane systolic elevation (p = 0.016). Moreover, we identified a decreased BDNF expression in patients with high-risk PE (p < 0.01), thrombolytic treatment (p = 0.01), and patients who died within 30 days (p = 0.05). (4) Conclusions: Our study revealed that plasma BNDF is significantly lower in patients with PE when compared with the general population, and may be considered as a promising biomarker in complementing the current diagnostic tools for PE. Furthermore, low levels of BDNF might also be used to predict a poor outcome of this condition. Full article
(This article belongs to the Special Issue Recent Advances in Pulmonary Embolism)
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Review

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10 pages, 1379 KiB  
Review
Pulmonary Embolism Response Teams: Theory, Implementation, and Unanswered Questions
by Antoine Bejjani, Candrika D. Khairani, Umberto Campia and Gregory Piazza
J. Clin. Med. 2022, 11(20), 6129; https://doi.org/10.3390/jcm11206129 - 18 Oct 2022
Cited by 3 | Viewed by 2192
Abstract
Pulmonary embolism (PE) continues to represent a significant health care burden and its incidence is steadily increasing worldwide. Constantly evolving therapeutic options and the rarity of randomized controlled trial data to drive clinical guidelines impose challenges on physicians caring for patients with PE. [...] Read more.
Pulmonary embolism (PE) continues to represent a significant health care burden and its incidence is steadily increasing worldwide. Constantly evolving therapeutic options and the rarity of randomized controlled trial data to drive clinical guidelines impose challenges on physicians caring for patients with PE. Recently, PE response teams have been developed and recommended to help address these issues by facilitating a consensus among local experts while advocating the management of acute PE according to each individual patient profile. In this review, we focus on the clinical challenges supporting the need for a PE response team, report the current evidence for their implementation, assess their impact on PE management and outcomes, and address unanswered questions and future directions. Full article
(This article belongs to the Special Issue Recent Advances in Pulmonary Embolism)
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14 pages, 307 KiB  
Review
Long-Term Management of Pulmonary Embolism: A Review of Consequences, Treatment, and Rehabilitation
by Anette Arbjerg Højen, Peter Brønnum Nielsen, Thure Filskov Overvad, Ida Ehlers Albertsen, Frederikus A. Klok, Nanna Rolving, Mette Søgaard and Anne Gulbech Ording
J. Clin. Med. 2022, 11(19), 5970; https://doi.org/10.3390/jcm11195970 - 10 Oct 2022
Cited by 3 | Viewed by 2387
Abstract
The concept of pulmonary embolism is evolving. Recent and emerging evidence on the treatment of specific patient populations, its secondary prevention, long-term complications, and the unmet need for rehabilitation has the potential to change clinical practice for the benefit of the patients. This [...] Read more.
The concept of pulmonary embolism is evolving. Recent and emerging evidence on the treatment of specific patient populations, its secondary prevention, long-term complications, and the unmet need for rehabilitation has the potential to change clinical practice for the benefit of the patients. This review discusses the recent evidence from clinical trials, observational studies, and guidelines focusing on anticoagulation treatment, rehabilitation, emotional stress, quality of life, and the associated outcomes for patients with pulmonary embolism. Guidelines suggest that the type and duration of treatment with anticoagulation should be based on prevalent risk factors. Recent studies demonstrate that an anticoagulant treatment that is longer than two years may be effective and safe for some patients. The evidence for extended treatment in cancer patients is limited. Careful consideration is particularly necessary for pulmonary embolisms in pregnancy, cancer, and at the end of life. The rehabilitation and prevention of unnecessary deconditioning, emotional distress, and a reduced quality of life is an important, but currently they are unmet priorities for many patients with a pulmonary embolism. Future research could demonstrate optimal anticoagulant therapy durations, follow-ups, and rehabilitation, and effective patient-centered decision making at the end of life. A patient preferences and shared decision making should be incorporated in their routine care when weighing the benefits and risks with primary treatment and secondary prevention. Full article
(This article belongs to the Special Issue Recent Advances in Pulmonary Embolism)
18 pages, 944 KiB  
Review
Pulmonary Embolism in the Cancer Associated Thrombosis Landscape
by Géraldine Poenou, Teona Dumitru Dumitru, Ludovic Lafaie, Valentine Mismetti, Elie Ayoub, Cécile Duvillard, Sandrine Accassat, Patrick Mismetti, Marco Heestermans and Laurent Bertoletti
J. Clin. Med. 2022, 11(19), 5650; https://doi.org/10.3390/jcm11195650 - 25 Sep 2022
Cited by 8 | Viewed by 2569
Abstract
In cancer patients, pulmonary embolism (PE) is the second leading cause of death after the cancer itself, most likely because of difficulties in diagnosing the disease due to its nonclassical presentation. The risk of PE recurrence and possibly the case-fatality rate depends on [...] Read more.
In cancer patients, pulmonary embolism (PE) is the second leading cause of death after the cancer itself, most likely because of difficulties in diagnosing the disease due to its nonclassical presentation. The risk of PE recurrence and possibly the case-fatality rate depends on whether the patient presents a symptomatic PE, an unsuspected PE, a subsegmental PE, or a catheter-related PE. Choosing the best therapeutic option is challenging and should consider the risk of both the recurrence of thrombosis and the occurrence of bleeding. The purpose of this review is to provide an overview of the clinical characteristics and the treatment of cancer-associated PE, which could benefit clinicians to better manage the deadliest form of thrombosis associated with cancer. After a brief presentation of the epidemiological data, we will present the current attitude towards the diagnosis and the management of cancer patients with PE. Finally, we will discuss the perspectives of how the medical community can improve the management of this severe medical condition. Full article
(This article belongs to the Special Issue Recent Advances in Pulmonary Embolism)
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17 pages, 3120 KiB  
Review
An Update on the Management of Acute High-Risk Pulmonary Embolism
by Romain Chopard, Julien Behr, Charles Vidoni, Fiona Ecarnot and Nicolas Meneveau
J. Clin. Med. 2022, 11(16), 4807; https://doi.org/10.3390/jcm11164807 - 17 Aug 2022
Cited by 8 | Viewed by 5128
Abstract
Hemodynamic instability and right ventricular (RV) dysfunction are the key determinants of short-term prognosis in patients with acute pulmonary embolism (PE). High-risk PE encompasses a wide spectrum of clinical situations from sustained hypotension to cardiac arrest. Early recognition and treatment tailored to each [...] Read more.
Hemodynamic instability and right ventricular (RV) dysfunction are the key determinants of short-term prognosis in patients with acute pulmonary embolism (PE). High-risk PE encompasses a wide spectrum of clinical situations from sustained hypotension to cardiac arrest. Early recognition and treatment tailored to each individual are crucial. Systemic fibrinolysis is the first-line pulmonary reperfusion therapy to rapidly reverse RV overload and hemodynamic collapse, at the cost of a significant rate of bleeding. Catheter-directed pharmacological and mechanical techniques ensure swift recovery of echocardiographic parameters and may possess a better safety profile than systemic thrombolysis. Further clinical studies are mandatory to clarify which pulmonary reperfusion strategy may improve early clinical outcomes and fill existing gaps in the evidence. Full article
(This article belongs to the Special Issue Recent Advances in Pulmonary Embolism)
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