Please use this identifier to cite or link to this item:
https://hdl.handle.net/10316/109808
DC Field | Value | Language |
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dc.contributor.author | Baptista, Rui Terenas | - |
dc.contributor.author | Santiago, Inês | - |
dc.contributor.author | Jorge, Elisabete | - |
dc.contributor.author | Teixeira, Rogério | - |
dc.contributor.author | Mendes, Paulo | - |
dc.contributor.author | Semedo, Luís Curvo | - |
dc.contributor.author | Castro, Graça | - |
dc.contributor.author | Monteiro, Pedro | - |
dc.contributor.author | Alves, Filipe Caseiro | - |
dc.contributor.author | Providência, Luís A. | - |
dc.date.accessioned | 2023-10-27T11:35:29Z | - |
dc.date.available | 2023-10-27T11:35:29Z | - |
dc.date.issued | 2013-01 | - |
dc.identifier.issn | 0870-2551 | pt |
dc.identifier.uri | https://hdl.handle.net/10316/109808 | - |
dc.description.abstract | Introduction: Contrast-enhanced multidetector computed tomography (MDCT) is useful for the diagnosis of pulmonary embolism (PE). However, current guidelines do not support its use for risk assessment in acute PE patients. Objectives: We compared the prognostic impact of MDCT-derived indices regarding mediumterm mortality in a population of intermediate- to high-risk PE patients, mostly treated by thrombolysis. Methods: Thirty-nine consecutive patients admitted to an intensive care unit with acute PE were studied. All patients had a pulmonary MDCT on admission to the emergency room as part of the diagnostic algorithm. We assessed the following MDCT variables: right ventricular/left ventricular diameter (RV/LV) ratio, arterial obstruction index, pulmonary artery-to-aorta diameter ratio and azygos vein diameter. A 33-month follow-up was performed. Results: Mean age was 59.1±19.6 years, with 80% of patients receiving thrombolysis. Followup all-cause mortality was 12.8%. Of the MDCT-derived variables, only the RV/LV ratio had significant predictive value, being higher in patients who suffered the endpoint (1.6±0.5 vs. 1.9±0.4, p=0.046). Patients with an RV/LV ratio ≥1.8 had 11-fold higher medium-term allcause mortality (3.8% vs. 38.8%, p<0.001). Regarding this endpoint, the c-statistic was 0.78 (95% CI, 0.60---0.96) for RV/LV ratio and calibration was good (goodness-of-fit p=0.594). No other radiological index was predictive of mortality. Conclusions: MDCT gives the possibility, in a single imaging procedure, of diagnosing and assessing the prognosis of patients with intermediate- to high-risk PE. Although further studies are needed, the simple-to-calculate RV/LV ratio has good discrimination and calibration for predicting poorer outcomes in patients with acute PE. | pt |
dc.description.abstract | Introduc¸ão: A angiografia pulmonar por tomografia computadorizada com contraste (angio-TC) é recomendada para o diagnóstico mas não para a estratificac¸ão de risco em doentes com tromboembolia pulmonar (TEP). Objectivos: Determinar o impacto prognóstico a médio-prazo de vários índices radiológicos obtidos na angio-TC em doentes com TEP de médio a alto risco, a maioria tratados com fibrinólise. Métodos: Estudaram-se 39 doentes admitidos numa unidade de cuidados intensivos por TEP, todos com angio-TC prévia realizada na urgência e seguiram-se durante 33 meses. Mediram-se as seguintes variáveis: razão entre os diâmetros do ventrículo direito e ventrículo esquerdo (índice VD/VE), índice de obstruc¸ão arterial, razão ente os diâmetros da artéria pulmonar e aorta e diâmetro da veia ázigos. Resultados: A idade média foi de 59,1 ± 19,6 anos; 80% dos doentes foram tratados com fibrinólise. Durante o período de seguimento clínico, a mortalidade foi 12,8%. Das variáveis analisadas, apenas o índice VD/VE demonstrou valor preditivo, sendo significativamente mais elevado nos doentes que faleceram (1,6 ± 0,5 versus 1,9 ± 0,4, p=0,046). Os doentes com um índice VD/VE ≥ 1,8 tiveram uma incidência 11 vezes superior de mortalidade a médio prazo (3,8% versus 38,8%, p < 0,001). Relativamente a este endpoint, o c-statistic foi de 0,78 (95% IC 0,60---0,96) e a calibrac¸ão elevada (goodness-of-fit p=0,594). Nenhum outro índice radiológico demonstrou associac¸ão com a mortalidade. Conclusões: A angio-TC permite num único exame, em doentes de médio e alto risco, diagnosticar e estratificar o risco da TEP. Apesar de serem necessários mais estudos, o índice VD/VE pode identificar doentes com pior prognóstico após uma TEP. | pt |
dc.language.iso | eng | pt |
dc.publisher | Elsevier | pt |
dc.rights | openAccess | pt |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/ | pt |
dc.subject | Pulmonary embolism | pt |
dc.subject | Prognosis | pt |
dc.subject | Right ventricular dysfunction | pt |
dc.subject | Thrombolysis | pt |
dc.subject | Multidetector computed tomography | pt |
dc.subject | Contrast | pt |
dc.subject | Tromboembolia pulmonar | pt |
dc.subject | Prognóstico | pt |
dc.subject | Disfunção ventricular direita | pt |
dc.subject | Trombólise | pt |
dc.subject | Tomografia computadorizada | pt |
dc.subject | Contraste | pt |
dc.subject.mesh | Acute Disease | pt |
dc.subject.mesh | Adult | pt |
dc.subject.mesh | Aged | pt |
dc.subject.mesh | Aged, 80 and over | pt |
dc.subject.mesh | Female | pt |
dc.subject.mesh | Humans | pt |
dc.subject.mesh | Male | pt |
dc.subject.mesh | Middle Aged | pt |
dc.subject.mesh | Prognosis | pt |
dc.subject.mesh | Pulmonary Embolism | pt |
dc.subject.mesh | Retrospective Studies | pt |
dc.subject.mesh | Risk Assessment | pt |
dc.subject.mesh | Risk Factors | pt |
dc.subject.mesh | Young Adult | pt |
dc.subject.mesh | Multidetector Computed Tomography | pt |
dc.title | One-shot diagnostic and prognostic assessment in intermediate- to high-risk acute pulmonary embolism: the role of multidetector computed tomography | pt |
dc.title.alternative | Angiografia pulmonar por tomografia computadorizada em doentes com tromboembolia pumonar de médio a alto risco: avaliação diagnóstica e prognóstica num só exame | pt |
dc.type | article | - |
degois.publication.firstPage | 7 | pt |
degois.publication.lastPage | 13 | pt |
degois.publication.issue | 1 | pt |
degois.publication.title | Revista Portuguesa de Cardiologia | pt |
dc.peerreviewed | yes | pt |
dc.identifier.doi | 10.1016/j.repc.2012.05.020 | pt |
degois.publication.volume | 32 | pt |
dc.date.embargo | 2013-01-01 | * |
uc.date.periodoEmbargo | 0 | pt |
item.fulltext | Com Texto completo | - |
item.languageiso639-1 | en | - |
item.openairecristype | http://purl.org/coar/resource_type/c_18cf | - |
item.openairetype | article | - |
item.grantfulltext | open | - |
item.cerifentitytype | Publications | - |
crisitem.author.researchunit | CNC - Center for Neuroscience and Cell Biology | - |
crisitem.author.orcid | 0000-0002-7411-7039 | - |
crisitem.author.orcid | 0000-0001-9397-6149 | - |
Appears in Collections: | FMUC Medicina - Artigos em Revistas Internacionais |
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File | Description | Size | Format | |
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One-shot diagnostic and prognostic assessment in intermediate-to high-risk acute pulmonary embolism The role of multidetector computed tomography.pdf | 217.28 kB | Adobe PDF | View/Open |
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