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Right ventricular function and thrombus load in patients with pulmonary embolism and diagnostic delay
S M Pasha1, F A Klok, N van der Bijl
1Department of Thrombosis and Haemostasis, Leiden University Medical Centre, Leiden, the Netherlands.
Journal of Thrombosis and Haemostasis : JTH
|November 29, 2013
Summary
Diagnostic delay in pulmonary embolism (PE) did not correlate with increased thrombus burden or impaired right ventricular function. This finding helps explain why delayed diagnosis in PE patients doesn't worsen prognosis.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Medical Imaging
Background:
- The prognostic impact of diagnostic delay in pulmonary embolism (PE) remains poorly understood.
- Previous reports suggest no difference in re-thrombosis or mortality risk despite delays.
- This study investigates thrombus load and right ventricular function in PE patients with and without diagnostic delay.
Purpose of the Study:
- To evaluate the relationship between diagnostic delay and objective measures of PE severity.
- To explore potential explanations for the counterintuitive finding that diagnostic delay does not affect PE prognosis.
Main Methods:
- Post hoc analysis of 113 consecutive PE patients from a prospective observational study.
- Assessment of Qanadli-score and right ventricle/left ventricle (RV/LV) ratio.
- Definition of diagnostic delay as >7 days from symptom onset to clinical presentation; 6-week mortality and readmission as endpoints.
Main Results:
- No significant association was found between diagnostic delay and Qanadli-score (P=0.130) or RV/LV ratio (P=0.991).
- Extended diagnostic delay did not predict 6-week mortality (OR 0.65) or hospital readmission (OR 0.75).
- Patient cohorts with and without delay exhibited comparable baseline characteristics.
Conclusions:
- Diagnostic delay in pulmonary embolism is not linked to increased thrombus load or right ventricular dysfunction.
- These findings offer a potential explanation for the observed lack of prognostic significance of diagnostic delays in PE patients.
Keywords:
delayed diagnosismultidetector computed tomographyoutcomes assessmentpulmonary embolismventricular function, rightMore Related Videos
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