Annals of Thoracic Medicine Official publication of the Saudi Thoracic Society, affiliated to King Saud University
 
Search Ahead of print Current Issue Archives Instructions Subscribe e-Alerts Login 
Home Email this article link Print this article Bookmark this page Decrease font size Default font size Increase font size


 
Table of Contents   
LETTER TO THE EDITOR
Year : 2014  |  Volume : 9  |  Issue : 3  |  Page : 181
Outcome of pulmonary embolism and clinico-radiological predictors of mortality: Experience from a university hospital in Saudi Arabia which was published in the recent issue of Annals of Thoracic Medicine


Consultant Pulmonary and Critical Care Medicine, Dammam Medical Complex, Dammam, Saudi Arabia

Date of Web Publication7-Jun-2014

Correspondence Address:
Abdullah H Alsaghir
Consultant Pulmonary and Critical Care Medicine, Dammam Medical Complex, Dammam
Saudi Arabia
Login to access the Email id


DOI: 10.4103/1817-1737.134079

PMID: 24987481

Rights and Permissions



How to cite this article:
Alsaghir AH, Alaithan SA. Outcome of pulmonary embolism and clinico-radiological predictors of mortality: Experience from a university hospital in Saudi Arabia which was published in the recent issue of Annals of Thoracic Medicine. Ann Thorac Med 2014;9:181

How to cite this URL:
Alsaghir AH, Alaithan SA. Outcome of pulmonary embolism and clinico-radiological predictors of mortality: Experience from a university hospital in Saudi Arabia which was published in the recent issue of Annals of Thoracic Medicine. Ann Thorac Med [serial online] 2014 [cited 2020 Jun 6];9:181. Available from: http://www.thoracicmedicine.org/text.asp?2014/9/3/181/134079


Sir,

We read with interest the study by Al Otair et al.,[1] in the recent issue of Annals of Thoracic Medicine entitled "Outcome of pulmonary embolism (PE) and clinico-radiological predictors of mortality: Experience from a university hospital in Saudi Arabia." They prospectively studied 105 patients with PE diagnosed by computed tomography pulmonary angiography (CTPA) and followed until death or hospital discharge. Their conclusion included there was no significant difference in localization of the embolus or obstruction score between survivors and non-survivors.

I agree with their conclusion, as the anatomical distribution and burden of embolic occlusion of pulmonary artery has conflicting results and hence is not currently recommended for prognostic purpose when compared with the assessment based on hemodynamic consequences of PE. A recent meta-analysis by Vedovati et al. showed no correlation was observed between obstruction index (according to the Qanadli scoring system) and 30 days mortality rate, but can be used for risk stratification in patients with acute PE.[2] In the contrary, some studies have reported that increase in right-to-left ventricular dimension ratio correlate with mortality. The 30 day mortality of patients with a right-to-left ventricular dimension ratio >0.9 was 16% versus 8% mortality of patients without right ventricular (RV) dilation.[3] Other CTPA signs of right-heart overload potentially contributing to risk stratification include the shape of the interventricular septum, main pulmonary artery width, pulmonary artery-to-aorta width ratio, decreased width of the left atrium and pulmonary veins.[4]

The other point which is worth commenting is the importance of measurement of the myocardial injury markers that includes cardiac troponins (troponins T and I) and the overload markers natriuretic peptides (brain natriuretic peptide [BNP]). In PE, elevation of cardiac troponin levels has been suggested to reflect its severity and is primarily used for risk stratification in hemodynamically stable normotensive patients. Some studies have shown that elevation of troponin level reflects RV dysfunction and is associated with increased mortality in PE patients. A meta-analysis investigating troponin levels in acute PE determined that any increase was associated with up to a five-fold increase in the risk of death.[5] Another meta-analysis has shown that increases in BNP levels are associated with a ninefold increase in the risk of death in normotensive PE patients.[6]

 
   References Top

1.Al Otair HA, Al-Boukai AA, Ibrahim GF, Al Shaikh MK, Mayet AY, Al-Hajjaj MS. Outcome of pulmonary embolism and clinico-radiological predictors of mortality: Experience from a university hospital in Saudi Arabia. Ann Thorac Med 2014;9:18-22.   Back to cited text no. 1
    
2.Vedovati MC, Germini F, Agnelli G, Becattini C. Prognostic role of embolic burden assessed at computed tomography angiography in patients with acute pulmonary embolism: systematic review and meta-analysis. J Thromb Haemost 2013;11:2092-102   Back to cited text no. 2
    
3.Schoepf UJ, Kucher N, Kipfmueller F, Quiroz R, Costello P, Goldhaber SZ. Right ventricular enlargement on chest computed tomography: A predictor of early death in acute pulmonary embolism. Circulation 2004;110:3276-80.   Back to cited text no. 3
    
4.Kang DK, Thilo C, Schoepf UJ, Barraza JM Jr, Nance JW Jr, Bastarrika G, et al. CT signs of right ventricular dysfunction: Prognostic role in acute pulmonary embolism. JACC Cardiovasc Imaging 2011;4:841-9.   Back to cited text no. 4
    
5.Becattini C, Vedovati MC, Agnelli G. Prognostic value of troponins in acute pulmonary embolism: A meta-analysis. Circulation 2007;116:427-33.   Back to cited text no. 5
    
6.Kostrubiec M, Pruszczyk P, Kaczynska A, Kucher N. Persistent NT-proBNP elevation in acute pulmonary embolism predicts early death. Clin Chim Acta 2007;382:124-8.  Back to cited text no. 6
    




 

Top
Print this article  Email this article
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (249 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    References

 Article Access Statistics
    Viewed1134    
    Printed23    
    Emailed0    
    PDF Downloaded257    
    Comments [Add]    

Recommend this journal