Right heart thrombi in pulmonary embolism.

There is a lack of comprehensive data on the prevalence, predictors and prognostic significance of right heart thrombi (RHT) in pulmonary embolism.In this study of patients with pulmonary embolism from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry, we assessed the prevalence and predictors of RHT, and the association between the presence of RHT and the outcomes of all-cause mortality, pulmonary embolism-related mortality, recurrences, and major bleeding through 30 days after initiation of pulmonary embolism treatment.Of 12 441 patients with pulmonary embolism and baseline echocardiographic data, 2.6% had RHT. The following increased the risk of RHT: younger age, previous bleeding, congestive heart failure, cancer, syncope, systolic blood pressure <100 mmHg, and arterial oxyhaemoglobin saturation <90%. Patients with RHT were significantly more likely to die from any cause (adjusted OR 2.50 (95% CI 1.62-3.84); p<0.001) and from pulmonary embolism (adjusted OR 4.29 (95% CI 2.45-7.48); p<0.001) during follow-up. RHT was associated with an increased risk of recurrence during follow-up (1.8% versus 0.7%; p=0.04). Major bleeding was similar in patients with and without RHT.In patients presenting with pulmonary embolism, RHT is relatively infrequent. Patients with RHT had a worse outcome when compared with those without RHT.

Periodontal disease as a risk factor of recurrence of venous thromboembolic disease: a prospective study.

BACKGROUND: In recent years, periodontal disease has been related to a large number of systemic disorders. OBJECTIVE: To study the possible relationship between periodontal disease and high levels of D-dimer in a group of patients with venous thromboembolic disease. MATERIALS AND METHODS: A study was made of 142 patients diagnosed with unprovoked venous thromboembolic disease. All patients underwent oral examination consecutively and randomly. Finally, two groups were obtained: (a) patients with periodontal disease (n = 71); and (b) patients without periodontal disease (n = 71). All patients were subjected to periodontal study, with evaluation of the number of teeth, bleeding index, gingival index, simplified oral hygiene index, community periodontal index of treatment needs, clinical attachment level, probe depth, number of pockets ≥4 mm, number of pockets ≥6 mm. The D-dimer values were evaluated in both groups. RESULTS: D-dimer values were higher in the study group than the control group, with statistically significant differences (p = 0.010). CONCLUSIONS: A relationship is observed between the presence of periodontal disease and high D-dimer levels. Patients with venous thromboembolic disease and periodontal disease could have more risk of a new thromboembolism episode.

Genotyping of the C>T allele of rs16906252, predictor of O16-methylguanine-DNA methyltransferase (MGMT) promoter methylation status, in erosive atrophic lesions of oral lichen planus.

BACKGROUND: DNA promoter methylation is usually an early stage in carcinogenesis process, including oral cancer. The purpose of this study was to investigate the association between T allele of specific single nucleotide polymorphism (SNP) C>T rs 16906252 and O16-methylguanine-DNA methyltransferase (MGMT) methylation as prospective biomarkers of malignant transformation in oral lichen planus (OLP), a chronic autoimmune mucocutaneous disease. METHODS: This research is an observational, analytical case-control study where a total of 85 subjects (43 control individuals and 42 OLP patients) participated. The samples (mouthwashes) from all volunteers were analyzed, and DNA extraction was carried out. The genotyping of the rs 16906252 SNP in the MGMT gene was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Statistical analyses of Student t test and multiple logistic regressions were used. RESULTS: C>T genotype in the control and OLP groups was detected in 2.3% and 19.0%, respectively. The presence of this genotype was associated with methylation of the MGMT gene. In fact, taking into account age and gender, subjects with C>T genotype were 10.5 (95% CI 1.03-106; P = 0.047) times more likely to methylate promoter region of the MGMT gene. CONCLUSIONS: These findings indicate that C>T allele of rs 16906252, predictor of MGMT promoter methylation status, may be an important feature in the clinical prognosis of premalignant lesions of OLP, although this finding requires further clinical and laboratory investigation.

Right ventricular dysfunction in acute pulmonary embolism: NT-proBNP vs. troponin T. / Disfunción del ventrículo derecho en la embolia pulmonar aguda: NT-proBNP frente a troponina T.

BACKGROUND AND OBJECTIVE: Dysfunction of the right ventricle (RV) is a parameter of severity in acute pulmonary embolism (PE). Echocardiographic assessment is not always possible in accident and emergency, hence the need to predict the presence of RV dysfunction using easily measurable parameters. To analyse the value of NT-proBNP and troponin T as markers of RV dysfunction in patients with acute PE. Secondarily, to assess the relationship between RV failure and clinical parameters related to PE. MATERIAL AND METHOD: Analytical, observational, cross-sectional and retrospective study comparing the values NT-proBNP, troponin T and presenting symptoms of PE among patients with and without RV dysfunction. RESULTS: One hundred seventy-two patients (52 with RV failure,120 without) were included. All symptoms occurred with similar frequency between the 2groups except dyspnea and syncope (more common in the group with RV failure). Both NT-proBNP and troponin T had significantly higher values in the group of patients with RV dysfunction. However, in the multivariate analysis, NT-proBNP had a higher explanatory value for RV failure than troponin T. CONCLUSION: NT-proBNP is a diagnostic parameter of RV dysfunction with higher sensitivity in the context of acute PE.

Prognostic Significance of Right Heart Thrombi in Patients With Acute Symptomatic Pulmonary Embolism: Systematic Review and Meta-analysis.

BACKGROUND: For patients diagnosed with acute pulmonary embolism (PE), the prognostic significance of concomitant right heart thrombi (RHT) lacks clarity. METHODS: We performed a meta-analysis of studies that enrolled patients with acute PE to assess the prognostic value of echocardiography-detectable RHT for the primary outcome of short-term all-cause mortality and the secondary outcome of short-term PE-related mortality. Unrestricted searches were conducted of PubMed and Embase from 1980 through January 31, 2016, and used the terms "right heart thrombi," "pulmonary embolism," and "prognos.*" A random effects model was used to pool study results; Begg rank correlation method was used to evaluate for publication bias; and I2 testing was used to assess for heterogeneity. RESULTS: Six of 79 potentially relevant studies met the inclusion criteria (15,220 patients). Overall, 99 of 593 patients with echocardiography-detectable RHT died (16.7% [95% CI, 13.8-19.9]) compared with 639 of 14,627 without RHT (4.4% [95% CI, 4.0-4.7]). RHT had a significant association with short-term all-cause mortality in all patients (OR, 3.0 [95% CI, 2.2 to 4.1]; I2 = 20%) and with PE-related death (three cohorts, 12,955 patients; OR: 4.8 [95% CI, 2.0-11.3; I2 = 76%). Results were consistent for the prospective (two cohorts, 514 patients; OR, 4.8 [95% CI, 1.7-13.6]; I2 = 56%) and the retrospective (four cohorts, 14,706 patients; OR, 2.8 [95% CI, 2.1 to 3.8]; I2 = 0%) studies. CONCLUSIONS: In patients diagnosed with acute PE, concomitant RHT were significantly associated with an increased risk of death within 30 days of PE diagnosis. TRIAL REGISTRY: PROSPERO registry; No.: CRD42016033960; URL: https://www.crd.york.ac.uk/prospero/.

Treatment of Right Heart Thrombi Associated with Acute Pulmonary Embolism.

BACKGROUND: Evidence-based recommendations do not adequately address the treatment of right heart thrombi in patients who present with acute symptomatic pulmonary embolism. METHODS: This study included patients who had acute pulmonary embolism associated with right heart thrombi and participated in the Registro Informatizado de la Enfermedad TromboEmbólica registry. We assessed the effectiveness of anticoagulation versus reperfusion treatment for the outcomes of all-cause mortality, pulmonary embolism-related mortality, recurrent venous thromboembolism, and major bleeding rates through 30 days after initiation of pulmonary embolism treatment. We used propensity score matching to adjust for the likelihood of receiving reperfusion treatment. RESULTS: Of 325 patients with pulmonary embolism and right heart thrombi, 255 (78%; 95% confidence interval, 74-83) received anticoagulation and 70 (22%; 95% confidence interval, 17-26) also received reperfusion treatment. Propensity score-matched pairs analyses did not detect a statistically lower risk of all-cause death (6.2% vs 14%, P = .15) or pulmonary embolism-related mortality (4.7% vs 7.8%; P = .47) for reperfusion compared with anticoagulation. Of the patients who received reperfusion treatment, 6.2% had a recurrence during the study follow-up period, compared with 0% of those who received anticoagulation (P = .049). The incidence of major bleeding events was not statistically different between the 2 treatment groups (3.1% vs 3.1%; P = 1.00). CONCLUSIONS: In patients with pulmonary embolism and right heart thrombi, no significant difference was found between reperfusion therapy and anticoagulant therapy for mortality and bleeding. The risk of recurrences was significantly higher for reperfusion therapy compared with anticoagulation. Right heart thrombi may not warrant riskier interventions than standard anticoagulation.

Multidisciplinary management of Paget-Schroetter syndrome. A case series of eight patients.

Paget-Schroetter syndrome (PSS) in the context of upper extremity deep venous thrombosis (DVT) is an uncommon but potentially very serious condition affecting young, healthy adults, in which secondary post-thrombotic syndrome (PTS) can be a complication with major implications. The best treatment option remains controversial, with current guidelines recommending anticoagulation for at least 3 months. However, an incidence of PTS of approximately 50% after 6 months, 30% after 1 year and 25% after 2 years has been found using this therapeutic approach. Consequently, specialized units recommend local thrombolysis and early decompressive surgery. We describe a series of eight cases treated in this way. None of the patients showed signs of complications, and an early return to regular activities with no PTS was observed in 90% of cases.

Association between periodontal disease and venous thromboembolic disease.

OBJECTIVE: In recent years, periodontal disease has been related to a large number of systemic disorders. The aim of this study was to find a relationship between periodontal disease and venous thromboembolic disease. METHOD AND MATERIALS: A total of 197 patients were included in the study, 97 patients with a diagnosis of venous thromboembolic disease and 100 healthy controls, in order to establish an association between these two conditions. All patients were subjected to periodontal examination, with evaluation of the number of teeth, Bleeding Index, Gingival Index, Simplified Oral Hygiene Index, Community Periodontal Index of Treatment Needs, Clinical Attachment Level, Probing Pocket Depth, number of pockets >= 4 mm, and number of pockets >= 6 mm. RESULTS: A high prevalence of periodontal disease was detected in patients with thromboembolic disease (P < .001). Bleeding Index, Gingival Index, Simplified Oral Hygiene Index, Clinical Attachment Level, and Probing Pocket Depth were higher in venous thromboembolic disease patients than in the control group (P < .001). CONCLUSION: A high prevalence of periodontal disease was detected in venous thromboembolic patients. There exists an association between periodontal disease and venous thromboembolic disease.

Embolia de pulmón con trombo en tránsito y foramen oval permeable: una fuente de embolismo paradójico mortal / Pulmonary embolism with in-transit thrombus and foramen ovale: a source of fatal paradoxical embolism

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Disfunción del ventrículo derecho en la embolia pulmonar aguda: NT-proBNP frente a troponina T / Right ventricular dysfunction in acute pulmonary embolism: NT-proBNP vs. troponin T

Introducción y objetivos: La disfunción del ventrículo derecho (VD) es un parámetro de gravedad en la embolia pulmonar (EP) aguda. La valoración ecocardiográfica no siempre es posible en urgencias, de ahí la necesidad de predecir la presencia de disfunción de VD mediante parámetros de fácil medición. Analizar el valor de NT-proBNP y troponina T como marcadores de disfunción del VD en los pacientes con EP aguda. Como objetivo secundario, valorar la relación entre fallo de VD y diferentes parámetros clínicos relacionados con la EP. Material y método: Estudio analítico, observacional, transversal y retrospectivo que compara los valores de NT-proBNP, troponina T y síntomas de presentación de EP entre pacientes con fallo de VD y sin fallo. Resultados: Se incluyeron 172 pacientes (52 con fallo de VD, 120 sin fallo de VD). Todos los síntomas se presentaron con similar frecuencia entre ambos grupos, salvo la disnea y el síncope (más frecuentes en el grupo con fallo de VD). Tanto el NT-proBNP como la troponina T presentaron valores significativamente mayores en el grupo de pacientes con fallo de VD. Sin embargo, el valor explicativo de fallo de VD fue mayor para el NT-proBNP en al análisis multivariante. Conclusión: El NT-proBNP se muestra como un parámetro diagnóstico de fallo de VD con mayor sensibilidad en el contexto de EP aguda (AU)

Background and objective: Dysfunction of the right ventricle (RV) is a parameter of severity in acute pulmonary embolism (PE). Echocardiographic assessment is not always possible in accident and emergency, hence the need to predict the presence of RV dysfunction using easily measurable parameters. To analyse the value of NT-proBNP and troponin T as markers of RV dysfunction in patients with acute PE. Secondarily, to assess the relationship between RV failure and clinical parameters related to PE. Material and method: Analytical, observational, cross-sectional and retrospective study comparing the values NT-proBNP, troponin T and presenting symptoms of PE among patients with and without RV dysfunction. Results: One hundred seventy-two patients (52 with RV failure,120 without) were included. All symptoms occurred with similar frequency between the 2groups except dyspnea and syncope (more common in the group with RV failure). Both NT-proBNP and troponin T had significantly higher values in the group of patients with RV dysfunction. However, in the multivariate analysis, NT-proBNP had a higher explanatory value for RV failure than troponin T. Conclusion: NT-proBNP is a diagnostic parameter of RV dysfunction with higher sensitivity in the context of acute PE (AU)

Síndrome de vena cava superior como primera manifestación de carcinoma tímico / Superior Vena Cava Syndrome as the Initial Manifestation of Thymic Carcinoma

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