Letter to the EditorRisk stratification of normotensive pulmonary embolism based on the sPESI — Does it work for all patients?
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Conflict of interest
The authors report no relationships that could be construed as a conflict of interest.
Acknowledgments
We thank Prof. Dr. Joachim Lotz, Department of Diagnostic and Interventional Radiology, Georg-August University of Göttingen, Germany and German Centre for Cardiovascular Research (DZHK), partner site Göttingen for images shown in Fig. 1.
The study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1003). The authors are responsible for the contents of this publication.
References (9)
- et al.
The Simplified Pulmonary Embolism Severity Index (PESI): validation of a clinical prognostic model for pulmonary embolism
J. Thromb. Haemost.
(2011) - et al.
ESC guidelines on the diagnosis and management of acute pulmonary embolism
Eur. Heart J.
(2014) - et al.
Predictive value of the high-sensitivity troponin T assay and the simplified Pulmonary Embolism Severity Index in hemodynamically stable patients with acute pulmonary embolism: a prospective validation study
Circulation
(2011) - et al.
Validation of N-terminal pro-brain natriuretic peptide cut-off values for risk stratification of pulmonary embolism
Eur. Respir. J.
(2014)
Cited by (16)
Need for Transthoracic Echocardiogram in Patients with Low-Risk Pulmonary Thromboembolism: A Systematic Review and Meta-Analysis
2020, Archivos de BronconeumologiaFactor Xa inhibition and sPESI failure in intermediate-high-risk pulmonary embolism
2018, American Journal of Emergency MedicineCitation Excerpt :We report one patient with THROMBI involving apixaban loading dose failure, where successful thrombolysis was performed 12 h after the last apixaban dose. Importantly, despite PE severity, simplified pulmonary embolism severity index (sPESI) failed twice to stratify risk in two consecutive ED admissions [11]. Considering the limited evidence of NOACs efficacy in THROMBI [1, 2] and the lack of safety recommendations in patients on NOACs who require urgent thrombolysis [12, 13], we performed a systematic review.
Risk stratification of acute pulmonary embolism based on clinical parameters, H-FABP and multidetector CT
2018, International Journal of CardiologyCitation Excerpt :For those patients, hospital admission and close monitoring seems reasonable, and according to the guidelines, thrombolysis might be considered, if signs of haemodynamic decompensation appear [2]. On the other hand, it has recently been debated, whether risk assessment of low risk patients should only rely on a clinical score [31]. In our cohort, the complication rate for an adverse 30-day outcome was 1.1% in patients with sPESI of 0.
High-sensitivity troponin and right ventricular function in acute pulmonary embolism
2016, American Journal of Emergency MedicineCitation Excerpt :There is sufficient evidence about the poor outcome of patients presenting hypotension with or without shock. However, most patients are normotensive and 70% are considered at intermediate risk, according to the scores recommended by the guidelines [17–21]. TAPSE has been validated as a prognostic parameter in PE, is easy to measure and has very low interobserver variability [8,22]; yet, it requires a bedside ultrasound, which is not available in many emergency departments.
Management of Pulmonary Embolism: An Update
2016, Journal of the American College of CardiologyCitation Excerpt :These criteria await validation in larger cohorts and further countries. Importantly, and in view of first reports that severe right ventricular dysfunction may occasionally be present in a patient with a negative sPESI (21), it will also need to be determined in this context whether CT or echocardiographic imaging of the right ventricle should be added to clinical eligibility criteria for immediate or early discharge in order to maximize patient safety. What are the next steps if a normotensive patient is not classified into the low-risk category on the basis of the clinical criteria described previously?
A Novel Composed Index to Evaluate the Right Ventricle Free-Wall Adaptation Against Ventricular Wall Stress in Acute Pulmonary Embolism
2023, Anatolian Journal of Cardiology
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The authors contributed equally.