Guidelines on the diagnosis and management of acute pulmonary embolism The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)European Heart JournalEur Heart J20082922762315

Department of Chest Medicine, Institute for Tuberculosis and Lung Diseases, Warsaw, Poland.
European Heart Journal (Impact Factor: 15.2). 09/2008; 29(18):2276-315.
Source: PubMed


Non-thrombotic PE does not represent a distinct clinical syndrome. It may be due to a variety of embolic materials and result in a wide spectrum of clinical presentations, making the diagnosis difficult. With the exception of severe air and fat embolism, the haemodynamic consequences of non-thrombotic emboli are usually mild. Treatment is mostly supportive but may differ according to the type of embolic material and clinical severity.

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Available from: Daniel Ferreira,
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    • "It is important to note that these scores have severe limitations. The Wells rule includes the physician's judgment of whether an alternative diagnosis is more likely than PE [11] [12] This criterion, which carries a major weight in the score, is subjective and cannot be standardized. Moreover, it has been suggested that the predictive value of the Wells rule is derived primarily from its subjective component [18]. "
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    ABSTRACT: Pulmonary Embolism (PE) is a common and potentially lethal condition. Most patients die within the first few hours from the event. Despite diagnostic advances, delays and underdiagnosis in PE are common. Moreover, many investigations pursued in the suspect of PE result negative and no more than 10% of the pulmonary angio-CT scan performed to confirm PE confirm the suspected di- agnosis. To increase the diagnostic performance in PE, current diagnostic work-up of patients with suspected acute pulmonary embolism usually starts with the assessment of clinical pretest probabil- ity using plasma d-Dimer measurement and clinical prediction rules. One of the most validated and widely used clinical decision rules are the Wells and Geneva Revised scores. However, both indices have limitations. We aimed to develop a new clinical prediction rule (CPR) for PE based on a new approach for features selection based on topological concepts and artificial neural network. Filter or wrapper methods for features reduction cannot be applied to our dataset: the application of these algorithms can only be performed on datasets without missing data. Alternatively, eliminating rows with null values in the dataset would reduce the sample size significantly and result in a covariance matrix that is singular. Instead, we applied Topological data analysis (TDA) to overcome the hurdle of processing datasets with null values missing data. A topological network was developed using the Ayasdi-Iris software (Ayasdi, Inc., Palo Alto). The PE patient topology identified two flares in the pathological group and hence two distinct clusters of PE patient populations. Additionally, the topological network detected several sub-groups among healthy patients that likely are affected with non-PE diseases. To be diagnosed properly even though they are not affected by PE, in a next study we will introduce also the survival curves for the patients. TDA was further utilized to identify key features which are best associated as diagnostic factors for PE and used this information to define the input space for a back-propagation artificial neural network (BP-ANN). It is shown that the area under curve (AUC) of BP-ANN is greater than the AUCs of the scores (Wells and revised Geneva) used among physicians. The results demonstrate topological data analysis and the BP-ANN, when used in combination, can produce better predictive models than Wells or revised Geneva scores system for the analyzed cohort. The new CPR can help physicians to predict the probability of PE.
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    • "However, the first and most crucial step is the clinical assessment of the patient. The clinical presentation of PE depends on a variety of factors including the size and the number of emboli, the chronicity of the presentation, and the presence of comorbidities [4]. When the diagnosis of PE is suspected, the use of clinical decision rules (CDS) improves the outcome for patients and reduces unnecessary imaging. "
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    ABSTRACT: This is a review of the current strengths and weaknesses of the various imaging modalities available for the diagnosis of suspected non-massive Pulmonary Embolism (PE). Without careful consideration for the clinical presentation, and the timely application of clinical decision support (CDS) methodology, the current overutilization of imaging resources for this disease will continue. For a patient with a low clinical risk profile and a negative D-dimer there is no reason to consider further workup with imaging; as the negative predictive value in this scenario is the same as imaging. While the current efficacy and effectiveness data support the continued use of Computed Tomographic angiography (CTA) as the imaging golden standard for the diagnosis of PE; this test does have the unintended consequences of radiation exposure, possible overdiagnosis and overuse. There is a persistent lack of appreciation on the part of ordering physicians for the effectiveness of the alternatives to CTA (ventilation-perfusion imaging and contrast enhanced magnetic resonance angiography) in these patients. Careful use of standardized protocols for patient triage and the application of CDS will allow for a better use of imaging resources. Copyright © 2015. Published by Elsevier Ireland Ltd.
    European journal of radiology 03/2015; 84(6). DOI:10.1016/j.ejrad.2015.03.023 · 2.37 Impact Factor
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    • "Until today, a large percentage of pulmonary embolisms go either undetected or the proper diagnosis is not made in time. International guidelines for the evaluation of pulmonary embolism recommend highdefinition computed tomography for first-line diagnosis (Torbicki et al. 2008, 2009), but its use is limited by availability and radiation exposure, particularly in young patients and when follow-up examinations are needed. Mortality has slightly decreased during the last decades probably because of the use of CT. "
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    ABSTRACT: The value of ultrasound techniques in examination of the pleurae and lungs has been underestimated over recent decades. One explanation for this is the assumption that the ventilated lungs and the bones of the rib cage constitute impermeable obstacles to ultrasound. However, a variety of pathologies of the chest wall, pleurae and lungs result in altered tissue composition, providing substantially increased access and visibility for ultrasound examination. It is a great benefit that the pleurae and lungs can be non-invasively imaged repeatedly without discomfort or radiation exposure for the patient. Ultrasound is thus particularly valuable in follow-up of disease, differential diagnosis and detection of complications. Diagnostic and therapeutic interventions in patients with pathologic pleural and pulmonary findings can tolerably be performed under real-time ultrasound guidance. In this article, an updated overview is given presenting not only the benefits and indications, but also the limitations of pleural and pulmonary ultrasound.
    Ultrasound in Medicine & Biology 02/2015; 41(2). DOI:10.1016/j.ultrasmedbio.2014.10.002 · 2.21 Impact Factor
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