Association between coronary artery stenosis and myocardial injury in patients with acute pulmonary embolism:A case-control study

Background:The potential impact of pre-existing coronary artery stenosis(CAS)on acute pulmonary embolism(PE)episodes remains underexplored.This study aimed to investigate the association between pre-existing CAS and the elevation of high-sensitivity cardiac troponin I(hs-cTnI)levels in patients with PE.Methods:In this multicenter,prospective case-control study,88 cases and 163 controls matched for age,sex,and study center were enrolled.Cases were patients with PE with elevated hs-cTnI.Controls were patients with PE with normal hs-cTnI.Coronary artery assessment utilized coronary computed tomographic angiography or invasive coronary angiography.CAS was defined as≥50%stenosis of the lumen diameter in any coronary vessel>2.0 mm in diameter.Conditional logistic regression was used to evaluate the association between CAS and hs-cTnI elevation.Results:The percentage of CAS was higher in the case group compared to the control group(44.3%[39/88]vs.30.1%[49/163];P=0.024).In multivariable conditional logistic regression model 1,CAS(adjusted odds ratio[OR],2.680;95%confidence interval[CI],1.243-5.779),heart rate>75 beats/min(OR,2.306;95%CI,1.056-5.036)and N-terminal pro-B type natriuretic peptide(NT-proBNP)>420 pg/mL(OR,12.169;95%CI,4.792-30.900)were independently associated with elevated hs-cTnI.In model 2,right CAS(OR,3.615;95%CI,1.467-8.909)and NT-proBNP>420 pg/mL(OR,13.890;95%CI,5.288-36.484)were independently associated with elevated hs-cTnI.Conclusions:CAS was independently associated with myocardial injury in patients with PE.Vigilance towards CAS is warranted in patients with PE with elevated cardiac troponin levels.

Emergency Hybrid Correction in a Newborn with Critical Aortic Valve Stenosis with Acute Pulmonary Edema in the First Hour after Birth

Critical aortic valve stenosis in newborns is the cause of a severe clinical condition with the onset of symptoms during first hours after birth.We present a clinical case of a successful surgical correction of a critical aortic stenosis using a hybrid method applied in a newborn during the first day of life.The infant was diagnosed with a hypoplastic left heart complex with an intact atrial septum(aortic and mitral valves stenosis variant),that led to the cardiogenic shock and acute pulmonary edema.The procedure included bilateral banding of the pulmonary artery branches and atrioseptostomy with stenting of the interatrial septum.The surgery was performed through a median sternotomy.

Multiple paradoxical embolisms caused by central venous catheter thrombus passing through a patent foramen ovale: A case report

BACKGROUND To date,this is the first case of a paradoxical embolism(PDE)that concurrently manifested in the coronary and lower limb arteries and was secondary to a central venous catheter(CVC)thrombus via a patent foramen ovale(PFO).CASE SUMMARY Here,we report a case of simultaneous coronary and lower limb artery embolism in a PFO patient carrier of a CVC.The patient presented to the hospital with acute chest pain and lower limb fatigue.Doppler ultrasound showed a large thrombus in the right internal jugular vein,precisely at the tip of the CVC.Transthoracic and transesophageal echocardiography confirmed the existence of a PFO,with inducible right-to-left shunting by the Valsalva maneuver.The patient was administered an extended course of anticoagulation therapy,and then the CVC was successfully removed.Percutaneous PFO closure was not undertaken.There was no recurrence during follow-up.CONCLUSION Thus,CVC-associated thrombosis is a potential source for multiple PDE in PFO patients.

Non-cardiogenic acute pulmonary edema in elderly patient with Dressier syndrome associated pulmonary embolism

Pulmonary embolism （PE） is a common cardiovascular and cardiopulmonary illness and the incidence increases exponentially with age. Because the clinical signs and symptoms are non-specific, its diagnosis is always difficult.

Effects of aspirin on the expression of nuclear factor-κB in a rat model of acute pulmonary embolism

BACKGROUND:Acute pulmonary embolism(APE) is a disorder involving the pulmonary circulation resulting from a blockage of the pulmonary artery. The present study aimed to investigate the effects of aspirin on the nuclear factor-κB(NF-κB) activity in a rat model of APE.METHODS:A total of 108 healthy male Sprague-Dawley rats were randomly assigned into six groups(n=18 rats per group):control group,sham operation group,APE model group,and low-,medium- and high-dose aspirin groups. Six,24,and 72 hours after the induction of APE,rats in the low-,medium- and high-dose aspirin groups were given aspirin at a respective daily dose of 150,300,and 600 mg/kg by gavage for three consecutive days. Rats in the other groups were treated with equal volumes of normal saline. Six rats in each group were anesthetized with 10% chloral hydrate solution at each time point,and then the lung tissues were collected and analyzed using immunohistochemical staining.RESULTS:Positive immunohistochemical staining was present in the bronchial epithelial cells,alveolar cells,macrophages,and surrounding bronchial smooth muscle cells. When compared with the APE model group,the number of positive cells was signif icantly lower in the other groups at each time point(P<0.001). Statistically signif icant differences were also observed among the aspirin-treated groups at 6 hours(P<0.05,P<0.001). Compared with the APE model group,NF-κB protein expression was reduced in the other groups at each time point(P<0.05,P<0.001). Rats from the APE model group had thrombosis,damaged alveolar walls,and pulmonary hemorrhage,along with different degrees of inf lammatory cellular inf iltration at each time point. However,pathological changes such as pulmonary hemorrhage and inf iltration of inf lammatory cells were attenuated after the aspirin treatment.CONCLUSION:Aspirin can signifi cantly inhibit NF-κB activity in the lung of rats with APE in a dose-dependent manner,and can alleviate lung injury after APE.

A fast-track diagnostic and therapeutic strategy for acute pulmonary embolism patients at peri-operational period

Acute pulmonary embolism(APE) in operation room is a constant,lethal but treatable disease.A fast determination of APE in an operation room is currently difficult due to a non-specificity on its signs,symptoms,electrocardiograph findings,arterial blood gas abnormalities and chest X-rays.Clinically,an APE can automatically originate from a small and clinically asymptomatic embolus to massive,proximal emboli with shock during a scheduled surgery period.An accurate,brief and prompt diagnostic and therapeutic strategy for APE in a peri-operation period is crucial for anesthesiologists to make a decision on an appropriate clinical intervention to improve patients' outcomes.The purpose of this mini-review article is to illuminate a fast-track diagnostic and therapeutic strategy for APE patients in a perioperative period through a hybrid of the high sensitive and high specific viable diagnostic modality of D-dimer assay in conjunction with necessary emergent pulmonary angiography(EPA),including digital subtraction angiography(DSA),or a spiral computed tomography angiography(sCTA) for APE patients' diagnosis and treatment during operation.The postulated fast-track diagnostic and therapeutic strategy can effectively confirm or exclude highly suspected APE and simultaneously provide fast therapeutic opportunities for APE patients at an operative period.

Anesthetic management for intraoperative acute pulmonary embolism during inferior vena cava tumor thrombus surgery:A case report

BACKGROUND Acute pulmonary embolism(APE)is a rare and potentially life-threatening condition,even with early detection and prompt management.Intraoperative APE required specific ways for detecting since classic symptoms of APE in the awake patient could not be observed or self-reported by the patient under general anesthesia.CASE SUMMARY A 44-year-old man with a history of hepatic cell carcinoma was admitted for radical nephrectomy and tumor thrombectomy due to a newly found kidney tumor with inferior vena cava(IVC)tumor thrombus.APE that occurred during tumor thrombectomy with hypercapnia and desaturation.The capnography combined with the transesophageal echocardiography(TEE)provided a crucial differential diagnosis during the operation.The patient was continuously managed with aggressive intravenous fluid resuscitation and blood transfusion under continuous cardiac output monitoring to maintain hemodynamic stability.He completed the surgery under stable hemodynamics and was extubated after percutaneous mechanical thrombectomy by a certified cardiologist.There were no significant symptoms and signs or obvious discomfort in the patient’s self-report during visits to the general ward.CONCLUSION Under general anesthesia for IVC tumor thrombus surgery,a sudden decrease in end-tidal carbon dioxide is the initial indicator of APE,which occurs before hemodynamic changes.When intraoperative APE is suspected,TEE is useful in the diagnosis and monitoring before computer tomography pulmonary angiogram.Timely clinical impression and supportive treatment and intervention should be conducted to obtain a better prognosis.

Increasing angiotensin-converting enzyme(ACE)2/ACE axes ratio alleviates early pulmonary vascular remodeling in a porcine model of acute pulmonary embolism with cardiac arrest

BACKGROUND:Acute pulmonary embolism(APE)with cardiac arrest(CA)is characterized by high mortality in emergency due to pulmonary arterial hypertension(PAH).This study aims to determine whether early pulmonary artery remodeling occurs in PAH caused by massive APE with CA and the protective effects of increasing angiotensin-converting enzyme(ACE)2-angiotensin(Ang)(1-7)-Mas receptor axis and ACE-Ang II-Ang II type 1 receptor(AT1)axis(ACE2/ACE axes)ratio on pulmonary artery lesion after return of spontaneous circulation(ROSC).METHODS:To establish a porcine massive APE with CA model,autologous thrombus was injected into the external jugular vein until mean arterial pressure dropped below 30 mmHg(1 mmHg=0.133 kPa).Cardiopulmonary resuscitation and thrombolysis were delivered to regain spontaneous circulation.Pigs were divided into four groups of five pigs each:control group,APE-CA group,ROSC-saline group,and ROSC-captopril group,to examine the endothelial pathological changes and expression of ACE2/ACE axes in pulmonary artery with or without captopril.RESULTS:Histological analysis of samples from the APE-CA and ROSC-saline groups showed that pulmonary arterioles were almost completely occluded by accumulated endothelial cells.Western blotting analysis revealed a decrease in the pulmonary arterial ACE2/ACE axes ratio and increases in angiopoietin-2/angiopoietin-1 ratio and expression of vascular endothelial growth factor(VEGF)in the APE-CA group compared with the control group.Captopril significantly suppressed the activation of angiopoietin-2/angiopoietin-1 and VEGF in plexiform lesions formed by proliferative endothelial cells after ROSC.Captopril also alleviated endothelial cell apoptosis by increasing the B-cell lymphoma-2(Bcl-2)/Bcl-2-associated X(Bax)ratio and decreasing cleaved caspase-3 expression.CONCLUSION:Increasing the ACE2/ACE axes ratio may ameliorate pulmonary arterial remodeling by inhibiting the apoptosis and proliferation of endothelial cells after ROSC induced by APE.

Changes and Significance of Cytokines in Serum of Rabbits with Acute Pulmonary Embolism

Objective:To observe the changes of cytokines in serum of rabbits with acute pulmonary embolism,and to provide a scientific basis for clinical treatment of the disease.Methods:The animal models of pulmonary embolism were established in 26 healthy rabbits by autologous thrombus reinfusion and normal saline injection,and the serum levels of cytokines(TNF-α,IL-1β,HGF)in the two groups were monitored by enzyme-linked immunosorbent assay.Results:The expression levels of serum inflamma­tory cytokines(TNF-α,IL-1β)increased in both groups of rabbits within 1-3 hours of the acute stage of embolism,but the expression levels of serum inflammatory cytokines in experimental group of rabbits with pulmonary embolism caused by thrombosis increased more obviously.There was no significant change in serum HGF of rabbits before and after embolization in group B.The serum HGF content of experimental rabbits at 1 h,3 h,12 h,24 h and 48 h after embolization was significantly higher than that before embolization.And in the acute stage of embolism(1-12 hours),it showed a gradual upward trend.Conclusions:The expression level of serum growth factor is different in different acute stages of pulmonary embolism.Detect­ing serum cytokines in rabbits with acute pulmonary embolism is of great reference significance for improving clinical diagnosis.

Diagnosis and treatment of acute pulmonary inflammation in critically ill patients: The role of inflammatory biomarkers

Pneumonia and acute respiratory distress syndrome are common and important causes of respiratory failure in the intensive care unit with a significant impact on morbidity, mortality and health care utilization despite early antimicrobial therapy and lung protective mechanical ventilation. Both clinical entities are characterized by acute pulmonary inflammation in response to direct or indirect lung injury. Adjunct anti-inflammatory treatment with corticosteroids is increasingly used, although the evidence for benefit is limited. The treatment decisions are based on radiographic, clinical and physiological variables without regards to inflammatory state. Current evidence suggests a role of biomarkers for the assessment of severity, and distinguishing sub-phenotypes (hyperinflammatory versus hypo-inflammatory) with important prognostic and therapeutic implications. Although many inflammatory biomarkers have been studied the most common and of interest are C-reactive protein, procalcitonin, and pro-inflammatory cytokines including interleukin 6. While extensively studied as prognostic tools (prognostic enrichment), limited data are available for the role of biomarkers in determining appropriate initiation, timing and dosing of adjunct anti-inflammatory treatment (predictive enrichment)

Acute pulmonary embolism originating from upper limb venous thrombosis following breast cancer surgery:Two case reports

BACKGROUND Upper limb venous thrombosis(ULVT)is rarer than lower-extremity deep venous thrombosis,and is related to Paget-Schroetter syndrome,central venous catheterization,and malignancy.There are few reports of pulmonary embolism(PE)from upper-extremity vein thrombosis due to surgery.Herein,we report two cases of PE that originated from upper limb venous thrombosis on the surgical side in two patients undergoing modified radical mastectomy for breast cancer.These cases challenge the traditional theory that PE originate only from the lower extremities.CASE SUMMARY We describe two female patients,aged 68 and 65 years,respectively,who had undergone modified radical mastectomy for breast cancer.They did not have a central venous catheter and did not undergo preoperative neoadjuvant chemotherapy.They were transferred to the intensive care unit due to symptomatic PE on the first day after surgery.Colour Doppler ultrasound identified fresh thrombosis in their upper limb veins,which was the presumed source of the PE.They all received anticoagulation therapy,and one of them experienced bleeding that required discontinuation of the drug.Ultimately,they were discharged in stable condition.CONCLUSION ULVT as a source of PE after breast cancer surgery cannot be ignored.

Missed acute pulmonary embolism and sudden death: A case report

Rationale: Pulmonary embolism is a severe cardiovascular disease. Acute pulmonary embolism is an extremely common and potentially the serious pattern of venous thromboembolic disease. Unfortunately, missed diagnosis of pulmonary embolism is lethal and common because of its non-specific symptoms and signs. Patient concerns: A 42-year-old male patient presented with acute chest pain that was treated as gastroesophageal reflux disease. Diagnosis: Suspected acute pulmonary embolism. Interventions: O2inhalation, urgent electrocardiography, and cardiopulmonary resuscitation. Outcomes: Deterioration and sudden cardiac death. Lessons: Physicians should pay much attention to the symptoms and signs of pulmonary embolism to reduce the rate of missed diagnosis.

The value of CT pulmonary angiography to the diagnosis of right ventricular dysfunction due to acute pulmonary embolism:compared with ultrasonographic cardiography

To analyze the value of CT pulmonary angiography（CTPA） in assessing right ventdcular dysfunction（RVD） after acute pulmonary embolism. Methods：Thirty-six patients with CTPA-confirmed PE who underwent ultrasonic cardiography（UCG） within the ensuing 24 hours were retrospectively reviewed. According to the severity of the disease, the patients were divided into the massive PE group（24 cases） and non-massive PE group（12 cases） respectively. CT scans were analyzed for findings suggestive of RVD. Scans were considered positive for RVD if the right ventricle was dilated（RVd/LVd 〉 1） or if the interventricular septum was straightened or deviated towards the left ventricle. Results were then compared with the results of UCG to estimate the value of CTPA in detecting RVD associated with PE, Results：In all cases, compared with UCG, the diagnostic sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, and negative predictive value of CTPA was 84.61%, 78.26%, 3.892, 0.197, 68.75% and 90% respectively. Kappa value was 0.60, which suggested moderate agreement between CTPA and UCG in the whole level. In the massive PE group, the diagnostic sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value of CTPA was 84.61%, 72.73%, 3.103, 0.212, 78.57% and 80% respectively. Kappa value was 0.58, which suggested moderate agreement between CTPA and UCG in the massive PE group. In the non-massive PE group, the diagnostic specificity of CTPA was 83.33%. By statistics, the value of RVd/LVd had significant difference between the massive PE and the non-massive PE group. Conclusion：CTPA can reliably detect RVD through the evaluation of cardiac morphology. However, this result requires confirmation using a larger prospective cohort study.

Prognostic Value of N-Terminal Pro-Brain Natriuretic Peptide in Acute Pulmonary Embolism

Patients with pulmonary embolism (PE) have a high risk of death and it is important to recognize factors associated with high mortality. N-Terminal pro-Brain Natriuretic Peptide (NT-pro BNP) has recently emerged as a promising biomarker for risk assessment in acute pulmonary embolism (PE). The aim of this study is to detect the in hospital prognostic value of NT-pro BNP in patients with acute (PE). Methods: This study included 64 patients diagnosed as (PE) with the mean age of 59.1 ± 16.5 years, 40 patients of them (62.5%) were male. All patients were subjected to 12 leads ECG. X-ray chest, laboratory tests including D-Dimer, troponin I, NT-pro BNP, Doppler ultrasound for the venous system of both lower limbs, Echocardiograhy and 64 multislices CT pulmonary angiography. Results: According to the admission level of NT-pro BNP our patients were divided into two groups: group I included 22 patients with normal NT-pro BNP (less than 300 pg/ml), and group II included 42 patients with elevated NT-pro BNP (more than or equal 300 pg/ml). Patients in group II were found to have a significantly higher incidence of heart failure (28.6% Vs 4.6%, p = 0.025), impaired kidney function (serum creatinine was 1.7 ± 0.6 Vs 1.1 ± 0.2, p = 0.018), tachypnea (85.7% Vs 54.5%, p = 0.006) and cardiogenic shock (26.2% Vs 0%, p = 0.014) but a significantly lower incidence of chest pain (21.4% Vs 45.5%, p = 0.04) and lower left ventricular ejection fraction (51.3% ± 16.9% Vs 67.3% ± 12.8%, p = 0.043) compared to group I. There were a significantly higher treatment with thrombolytic therapy (35.7% Vs 9.1%, p=0.021) and positive inotropics (35.71% Vs 4.55%, p = 0.006) in group II compared to group I. Also group II had a higher need for mechanical ventilation (26.12% Vs 4.55%, p = 0.04) and a longer in hospital stay (19.5 ± 10.3 Vs 5.3 ± 4.5, p = 0.001) than group I. The in hospital mortality was significantly higher in group II compared to group I (19.05% Vs 0.0%, p = 0.042). Conclusion: Elevated NT-pro BNP levels in patients with (PE) are associated with worse short term prognosis in terms of higher morbidity and mortality and it could be used as a valuable prognostic parameter and good indicator for the need of more aggressive therapy.

Diagnostic value of lead corrected Vt and V6 in patients with acute pulmonary thromboembolism

Objective: To investigate the diagnostic value of lead corrected Vt and V6 in patients with acute pulmonary thromboembolism. Methods: A total of 89 patients with suspected acute PTE were examined in our hospital from January to December 2017. A baseline 12-lead ECG was recorded on admission, with a gain of 10 mm/mV and a paper velocity of 25 mm/s. Results: Of the 89 suspected PTE patients enrolled in this study, 45 patients with acute PTE and 44 patients without PTE were identified by CTA. The chief complaint of most patients in both groups was dyspnea or dyspnea, with no significant difference between the two groups. The levels of d-dimer and high-sensitivity troponin in patients with PTE were significantly higher than those without PTE. QT and QTc in the V1 lead in the PTE group were significantly greater than those in the non-PTE group, but QT and QTc in the V6 lead were not significantly different between the two groups. The QTc difference (V1-V6) in the PTE group was significantly greater than that in the non-PTE group. In the morphological analysis, T wave inversion in lead III of PTE group, T wave inversion of V1 or V1 and V2 was significantly higher than that of non-PTE group. There was no significant difference in the incidence of S1Q3T3 between the two groups. For the prediction of acute PTE, the maximum accuracy of the maximum QTc difference (V1-V6)≥20 ms, the sensitivity was 83.2%, and the specificity and positive predictive value was 100%. T-wave inversion in V1 leads is the most sensitive morphological abnormality associated with PTE with a sensitivity of 80.06% and a specificity of 62.29%. T-wave inversion in lead III is a sub-sensitive predictor with a sensitivity of 51.20%. The specificity is 70.53%. Conclusions: The QTC difference (V1-V6) is a distinct feature of acute PTE, and QTC difference (V1-V6)≥20 ms as an important indicator of acute PTE in emergency settings.

Acute Pulmonary Embolism, Multiple Coronary Thrombosis, and Thrombi in the Left Ventricle and Ascending Aorta in a Patient with COVID-19 Infection

Both arterial and venous thromboembolic events are common in patients hospitalized in intensive care units with severe COVID-19. These patients often have laboratory findings consistent with a hypercoagulable state, suggesting widespread thrombosis and fibrinolysis, as well as elevated levels of D-dimer, von Willebrand factor (VWF), and factor VIII. There is increasing evidence that these thromboembolic events are associated with worse outcomes. We present the case of a 61-year-old man admitted for bilateral pneumonia due to COVID-19 infection, who developed during his hospitalization;Bilateral pulmonary thromboembolism, an acute myocardial infarction due to multiple coronary thrombosis, an intracavitary thrombus and thrombus in the ascending aorta. The patient was treated with systemic fibrinolysis and full doses of anticoagulation for pulmonary embolism, an emergency primary percutaneous coronary intervention (PCI) was performed with the implant of a drug eluting stent (DES) in the left anterior descending artery (LAD). Triple therapy with aspirin, clopidogrel and heparin was maintained until discharge. After the patient discharge, aspirin was stopped and treatment with clopidogrel and dabigatran was maintained for three months. In a subsequent outpatient control, the thrombi of the left ventricle and the ascending aorta resolved.

Significance of D-dimer assay in the diagnosis of acute pulmonary embolism after deep second-degree burn in rabbits

Objective: To explore the significance of D-dimer assay in the diagnosis of acute pulmonary embolism (APE) after deep second-degree burn by detecting the changes of plasma D-dimer in rabbits with deep second-degree burn and in different phases of burn with concomitant pulmonary embolism. Methods: 48 healthy male or female Chinese white rabbits, were randomly divided into: control group, burn group, burn shock group, burn shock + pulmonary embolism group, burn infection group and burn infection + pulmonary embolism group, with 8 rabbits in each group. By use of the ELISA method, the plasma D-dimer was determined on 1 d, 3 d, 5 d, 7 d, 14 d and 21 d after modeling in the burn group and the control group, and the plasma D-dimer in other groups was detected in 30 min, 1 h, 3 h, 6 h, 24 h after modeling. Results: The expression of D-dimer in the burn group was higher than that in the control group on 1 d, 3 d, 5 d and 7 d (p < .05). There were significant differences in the expression of D-dimer in the burn shock + pulmonary embolism group in comparison to the burn shock group (p < .05). There were also some significant differences in the expression of D-dimer in the burn infection+ pulmonary embolism group in comparison with the burn shock + pulmonary embolism group (p < .05). Conclusions: There were some differences in the expression of D-dimer in each group. D-dimer can be used as one of diagnostic indexes for deep second-degree burn with pulmonary embolism.

THE PREDICTIVE VALUE OF ELECTROCARDIOGRAPHIC S_ⅠQ_ⅢT_Ⅲ PATTERN IN ACUTE PULMONARY EMBOLISM

Objective:To evaluate the predictive value of electrocardiographic SⅠQⅢTⅢ pattern in patients with acute pulmonary embolism . Method: ECG was analyzed retrospectively in 102 patients with acute pulmonary embolism confirmed by spiral CT scan and Compared the clinical data between SⅠQⅢTⅢ positive and negative group. Result: In 102 patients 29 cases have positive SⅠQⅢTⅢ , positive rate was 28.4%. In SⅠQⅢTⅢ positive group and SⅠQⅢTⅢ negative group, 41.4% vs 69.9% have vulnerable diagnosis before admitted, respectively(P < 0.05),as well as the massive PE 48.3% vs 23.3% (P < 0.05),mortality rate 24.1% vs 10.9(P < 0.05),bilateral PE 86.3% vs 65.8%(P < 0.05) and right side PE 10.3% vs 31.5%(P < 0.05).Conclusion : positive Electrocardiographic SⅠQⅢTⅢ could not be served as the basic diagnosis criteria for acute PE . positive SⅠQⅢTⅢ ECG could decrease the misdiagnosis of acute PE, indicate higher possibility of bilateral and massive acute PE.

A machine learning model for diagnosing acute pulmonary embolism and comparison with Wells score,revised Geneva score,and Years algorithm

Background:Acute pulmonary embolism(APE)is a fatal cardiovascular disease,yet missed diagnosis and misdiagnosis often occur due to non-specific symptoms and signs.A simple,objective technique will help clinicians make a quick and precise diagnosis.In population studies,machine learning(ML)plays a critical role in characterizing cardiovascular risks,predicting outcomes,and identifying biomarkers.This work sought to develop an ML model for helping APE diagnosis and compare it against current clinical probability assessment models.Methods:This is a single-center retrospective study.Patients with suspected APE were continuously enrolled and randomly divided into two groups including training and testing sets.A total of 8 ML models,including random forest(RF),Naïve Bayes,decision tree,K-nearest neighbors,logistic regression,multi-layer perceptron,support vector machine,and gradient boosting decision tree were developed based on the training set to diagnose APE.Thereafter,the model with the best diagnostic performance was selected and evaluated against the current clinical assessment strategies,including the Wells score,revised Geneva score,and Years algorithm.Eventually,the ML model was internally validated to assess the diagnostic performance using receiver operating characteristic(ROC)analysis.Results:The ML models were constructed using eight clinical features,including D-dimer,cardiac troponin T(cTNT),arterial oxygen saturation,heart rate,chest pain,lower limb pain,hemoptysis,and chronic heart failure.Among eight ML models,the RF model achieved the best performance with the highest area under the curve(AUC)(AUC=0.774).Compared to the current clinical assessment strategies,the RF model outperformed the Wells score(P=0.030)and was not inferior to any other clinical probability assessment strategy.The AUC of the RF model for diagnosing APE onset in internal validation set was 0.726.Conclusions:Based on RF algorithm,a novel prediction model was finally constructed for APE diagnosis.When compared to the current clinical assessment strategies,the RF model achieved better diagnostic efficacy and accuracy.Therefore,the ML algorithm can be a useful tool in assisting with the diagnosis of APE.

Pulmonary embolism secondary to acute anterior ST-elevation myocardial infarction:a case report

Thrombophilia denotes a condition,whether acquired or hereditary,characterized by increased susceptibility to hypercoagulation.[1]This condition was first described in 1965,coinciding with the discovery of an inherited predisposition to venous thromboembolism(VTE)in patients deficient in antithrombin III.[2]While arterial and venous thromboses are common in hospitalized patients,acute myocardial infarction(AMI)and pulmonary embolism(PE)stand out as lifethreateningconditions.However,theoccurrenceof AMI complicated by PE is exceedingly rare,especially when considering cases where paradoxical embolism originating from a patent foramen ovale is absent.This report presents a case of AMI complicated with PE.A comprehensive understanding of the pathophysiology of this rare yet critical condition is important for ensuring prompt diagnosis and treatment.