CTEPH is an uncommon complication of COVID-19: UK national surveillance and observational screening cohort studies.

INTRODUCTION: Pulmonary embolism (PE) is a well-recognised complication of COVID-19 infection, and chronic thromboembolic pulmonary disease with and without pulmonary hypertension (CTEPD/CTEPH) are potential life-limiting consequences. At present the burden of CTEPD/CTEPH is unclear and optimal and cost-effective screening strategies yet to be established. METHODS: We evaluated the CTEPD/CTEPH referral rate to the UK national multidisciplinary team (MDT) during the 2017-2022 period to establish the national incidence of CTEPD/CTEPH potentially attributable to COVID-19-associated PE with historical comparator years. All individual cases of suspected CTEPH were reviewed by the MDT for evidence of associated COVID-19. In a separate multicentre cohort, the risk of developing CTEPH following hospitalisation with COVID-19 was calculated using simple clinical parameters at a median of 5 months post hospital discharge according to existing risk scores using symptoms, ECG and NT pro-BNP. RESULTS: By the second year of the pandemic, CTEPH diagnoses had returned to the pre-pandemic baseline (23.1 versus 27.8 cases per month, p=0.252). Of 334 confirmed CTEPD/CTEPH cases, 4 (1.2%) patients were identified to have CTEPH potentially associated with COVID-19 PE, and a further 3 (0.9%) CTEPD without PH. Of 1094 patients (mean age 58 years, 60.4% male) hospitalised with COVID-19 screened across the UK, 11 (1.0%) were at high risk of CTEPH at follow-up, none of whom had a diagnosis of CTEPH made at the national MDT. CONCLUSION: A-priori risk of developing CTEPH following COVID-19-related hospitalisation is low. Simple risk scoring is a potentially effective way of screening patients for further investigation.

Valor pronóstico de la ecocardiografía transtorácica en pacientes estables hemodinámicamente con tromboembolia de pulmón aguda sintomática / Prognostic value of transthoracic echocardiography in hemodynamically stable patients with acute symptomatic pulmonary embolism

Objetivo: El objetivo de este estudio ha sido evaluar el valor pronóstico de la ecocardiografía transtorácica en pacientes estables hemodinámicamente con diagnóstico de tromboembolia pulmonar (TEP) aguda sintomática. Pacientes y métodos: Se incluyó prospectivamente en el estudio a todos los pacientes ambulatorios, estables hemodinámicamente, diagnosticados de TEP aguda sintomática en un hospital universitario terciario. Se realizó a todos ellos una ecocardiografía transtorácica en las 48 h posteriores al diagnóstico. El criterio de evaluación principal fue la muerte por todas las causas a un mes. Resultados: La prevalencia de criterios ecocardiográficos de disfunción del ventrículo derecho fue de un 40% en nuestra serie (86/214). Durante el primer mes de seguimiento se produjeron 7 fallecimientos, 4 en el grupo con ecocardiografía positiva y 3 en el grupo con ecocardiografía negativa (odds ratio = 2,0; intervalo de confianza del 95%, 0,4-9,3; p = 0,41). La ecocardiografía transtorácica demostró un valor predictivo negativo del 98%, un valor predictivo positivo del 5% y un cociente de probabilidad negativo de 0,7 respecto al parámetro de valoración principal. Cuando sólo se consideró la muerte por TEP, el valor predictivo negativo fue del 100% y el valor predictivo positivo, del 3%. Conclusiones: En nuestro medio la ecocardiografía transtorácica carece de utilidad en la estratificación pronóstica de los pacientes estables hemodinámicamente con TEP

Objective: To determine the prognostic value of transthoracic echocardiography in hemodynamically stable patients diagnosed with acute symptomatic pulmonary embolism. Patients and Methods: Hemodynamically stable outpatients diagnosed with acute symptomatic pulmonary embolism at a tertiary university hospital were prospectively included in the study. All patients underwent transthoracic echocardiography within 48 hours of diagnosis. The primary endpoint was all-cause mortality at 1 month. Results: Right ventricular dysfunction was documented by echocardiography in 86 of the 214 patients (40%) in our series. In the first month of follow-up, 7 patients died--4 with positive echocardiographic findings and 3 with negative findings (odds ratio, 2.0; 95% confidence interval, 0.4-9.3; P=.41). For the primary endpoint, the negative predictive value of transthoracic echocardiography was 98%, the positive predictive value was 5%, and the negative likelihood ratio was 0.7. The negative predictive value was 100% and the positive predictive value was 3% when we analyzed death due to pulmonary embolism only. Conclusions: In our setting, transthoracic echocardiography is not useful for prognostic stratification of hemodynamically stable patients with pulmonary embolism

Estimación de la severidad de la insuficiencia mitral según un método simplificado basado en el flujo de convergencia proximal / Evaluation of mitral regurgitation severity using a simplified method based on proximal flow convergence

Introducción y objetivos. El cálculo del orificio regurgitante efectivo (ORE) se considera el método más fiable para estimar la severidad de la insuficiencia mitral (IM), pero es poco usado por su complejidad. El objetivo fue modificar y validar un método semicuantitativo basado en la proximal isovelocity surface area (PISA), previamente publicado, para adaptarlo a las recientes recomendaciones de las sociedades americana y europea de cardiología. Métodos. Cuando usamos el método PISA, el flujo regurgitante máximo (FRM) es una función del radio y la velocidad de aliasing (Va). Esta relación permite la creación de un normograma formado por líneas de diferentes valores de FRM que se pueden obtener con facilidad al buscar en el gráfico los valores del radio y su cruce con los de Va. Los límites de severidad en esa tabla se han adaptado para que reflejen los grados y los límites de severidad recomendados por las sociedades americana y europea de cardiología según el valor de ORE. Resultados. Estudiamos a 76 pacientes con IM mediante eco-Doppler. Se encontró una correlación excelente entre FRM y ORE (r = 0,98; p < 0,001). La estimación de severidad mediante el nuevo normograma mostró una concordancia excelente con la determinada mediante el ORE, con un valor de kappa de 0,951 y un error estándar de 0,11 para una escala en 3 grados, y un valor de kappa de 0,969 y error estándar de 0,11 para la escala en 4 grados. Conclusiones. La estimación semicuantitativa de la severidad de la IM mediante el FRM mediante el normograma propuesto tiene un acuerdo excelente con la estimación cuantitativa por ORE, pero es mucho más simple y rápida

Introduction and objectives. Calculation of the effective regurgitant orifice (ERO) is regarded as the most accurate way of assessing the severity of mitral regurgitation (MR), but the technique's complexity limits its use. Our objective was to modify and validate a previously published semiquantitative method of assessment based on measurement of the proximal isovelocity surface area (PISA) in order to adapt it to recent recommendations from American and European cardiology societies. Methods. In the PISA method, maximum regurgitant flow (MRF) is a function of the radius and aliasing velocity (AV). Using this relationship, it is possible to construct a nomogram formed by lines of different MRF value, which can be easily derived by looking for radius values on the graph and observing where they cross with AV values. The MR severity limits on the nomogram were set to reflect the different severity grades and limits recommended for use with ERO measurements by American and European cardiology societies. Results. We studied 76 patients with MR using Doppler echocardiography. There was an excellent correlation between MRF and ERO (r=0.98, P<.001). Estimates of MR severity made using the new nomogram were in good agreement with those derived from the ERO: for a scale with three severity grades, kappa was 0.951 and the standard error was 0.11; for four grades, kappa was 0.969 and the standard error, 0.11. Conclusions. Estimates of MR severity derived semiquantitatively from MRF using the nomogram proposed here were in excellent agreement with quantitative estimates obtained using the ERO, and the method was faster and easier to use