Acute pulmonary embolism in COVID-19 pandemic: prevalence and intrahospital outcome: a single center experience

Abstract Funding Acknowledgements Type of funding sources: None. Purpose We want to evaluate clinical, laboratory profiles and intra-hospital outcome in patients with acute PE treated in intensive care unit in the period of COVID-19 pandemic. Methods This is a single center, retrospective cohort study of patients with confirmed acute PE admitted in Intensive Cardiac Care Unit of a tertiary level university hospital between January and December 2020. Detailed history, risk factors, laboratory parameters and treatment strategy based on patient risk were assessed. All patients underwent 2-dimensional echocardiography, lower limb venous Doppler and CT pulmonary angiography (CTPA). sPESI score and intra-hospital outcomes were evaluated in all patients. Nasopharyngeal smear and real-time reverse transcriptase–polymerase chain reaction (RT-PCR) assay was performed in order to confirm COVID-19 infection. Results We studied 47 patients with acute PE treated in our ICU, with mean age 58.6 ± 19.4 years. Eight patients (17%) had massive PE (central thrombus) and 39 (83%) had sub massive PE (subsegmental thrombus) confirmed by CTPA. Six patients (12,7%) had history of deep vein thrombosis (DVT), 3 patients (6,3%) had history of prior PE, 4 patients (8,5%) were operated within 3 months, 7 patients (14,8%) had history of malignancy, 24 patient’s had increased body weight and obesity (51%). Twelve patients (25,5%) were tested for COVID 19 with real-time reverse transcriptase–polymerase chain reaction (RT-PCR) assay, and 3 come positive (12.5%). Eight patients were high risk with shock (17%), intermediate high risk were 29 patients (61.7%) and intermediate low risk were 10 patients (21.3%).  sPESI score was &amp;gt;1 in all 47 patients. Abnormal RV function with PAH was found in 32 patients (68%). Five high risk, unstable patients died within 72 hours of admission, resulting in an overall ICU mortality rate of 10,6% and 62.5% mortality rate in patients with cardiogenic shock. Patients with PE and COVID-19 had significantly higher D-dimer and hs-Troponin I levels comparing to the patients with patients negative for COVID-19. Multivariate logistic regression analysis showed thrombolytic therapy OR 2.145 (95% CI: 1.105−4,512), D-Dimers &amp;gt;4.500 ng/ml OR 1.893 (95% CI: 0.932–3.241), high risk PE OR 3.98 (95% CI: 1.396−5.641) and acute renal failure OR 2.421 (95% CI: 1.105−4.762) as independent mortality predictors. Eight patients have been treated with fibrinolysis (t-PA), and 39 patients with Heparin therapy. 40 survived patients were discharged with NOAC treatment (95,2%). Conclusions Pulmonary embolism cardiology clinic ICU admission in the period of COVID-19 pandemic decreased, with increase of PE severity, patients risk and mortality rate. Thrombolytic therapy, D-Dimers &amp;gt;4.500 ng/ml, high risk PE and acute renal failure were independent mortality predictors. Thrombolysis was successful treatment for high risk patients with low bleeding risk. </jats:sec

P1351 Right ventricular diameter added to D-dimer independently influence on prognosis of patients with pulmonary embolism and intermediate risk

Abstract Purpose The paper was aimed to determine predictors for of patients with pulmonary embolism (PE) and intermediate risk. Methods 84 patients with PE from National registry on VTE (age 60.3 + 12.5 years) were selected in a prospective study. Bedside echocardiography was done in all of them. Pulmonary embolism was confirmed by CT angiography. They were stratified as intermediate risk pts due to simplified PESI score &amp;gt; 1. Study population was followed up for 6.7 months. Multivariate regression analysis was done when right ventricular diameter (RV, mean 37.5 mm), systolic pulmonary artery pressure (68 + 23 mmHg), measured by echocardiography, D-dimer level at baseline 2654.5 + 420,3ng/ml, number of comorbidities (2.4 + 0,7) and occurred symptoms (3.1 + 0,9) entered the model. A model was adjusted for age. Results D-dimer revealed as a predictor for length of hospitalization (β 0,25, p 0,05), and RV diameter as a factor for duration of anticoagulation (β 0,29, p 0,05). Conclusion Our results imply that baseline measurement of right ventricular diameter when added to D-dimer independently influence on short and long term prognosis of patients with pulmonary embolism and intermediate risk. </jats:sec

The effect of copper content in the matte on the distribution coefficients between the slag and the matte for certain elements in the sulphide copper concentrate smelting process

This paper presents the results of investigating the dependence of distribution coefficient LS/MMe for: Cu, Zn, Pb, Sb, As, Ni, Ag, Au and Bi, between the slag and the matte, on the copper content in matte. The research was conducted under industrial conditions of copper concentrate smelting, in the reverberatory furnace in the copper smelter in Bor, Serbia. It was found that with the increase of the copper content in the matte, distribution coefficient between slag and matte for Cu, Zn and Pb increases, for Ag and Se decreases, while for Ni, As and Sb has an insignificant change. Au and Bi are almost entirely concentrated in the matte

Echocardiographic findings on aortic stenosis: an observational, prospective, and multi-center registry

Background: The aim of this aortic stenosis registry was to investigate the changes of routine echocardiographic indices and strain in patients with moderate-to-severe aortic stenosis over a 6-month follow-up period. Methods: Our aortic stenosis registry is observational, prospective, multicenter registry of nine countries, with 197 patients with aortic valve area less than 1.5 cm2. The enrolment took place from January to August 2017. We excluded patients with uncontrolled atrial arrhythmias, pulmonary hypertension or cardiomyopathies, as well as those with hemodynamically significant valvular disease other than aortic stenosis. We included patients who did not require intervention and who had a complete follow-up study. Results: In patients with preserved ejection fraction, left ventricular mass has significantly increased between baseline and follow-up studies (218 ± 34 grams vs 253 ± 29 grams, p = 0.02). However, when indexed to body surface area, there was no significant difference. Left ventricular global longitudinal strain significantly decreased (-19.7 ± -4.8 vs (-16.4 vs -3.8, p = 0.01). Left atrial volume was significantly higher at follow-up (p = 0.035). Right ventricular basal diameter and mid-cavity diameter were greater at the follow-up (p = 0.04 and p = 0.035, respectively). Patients with low-flow low-gradient aortic stenosis had significantly lower global longitudinal strain (-12.3% ± -3.9% vs -19.7% ± -4.8%, p = 0.01). Conclusion: Left atrial dilatation is one of the first changes to take place in low-flow low-gradient aortic stenosis patients even when left ventricular dimensions and function remains intact. Global longitudinal strain is an important determinant of left ventricular systolic and diastolic dysfunction and right ventricular function is an important parameter of aortic stenosis assessment. Accordingly, our registry has further shed the light on these indices role as multisite follow-up of aortic stenosis

2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (vol 290, pg 140, 2019)

Cardiolog

2019 ESC/EAS guidelines for the management of dyslipidemias: Lipid modification to reduce cardiovascular risk (vol 290, pg 140, 2019)

Cardiolog