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1. Clinical features and short-term outcomes of cancer patients with suspected and unsuspected pulmonary embolism: the EPIPHANY study.

Author

Font C, Carmona-Bayonas A, Beato C, Reig Ò, Sáez A, Jiménez-Fonseca P, Plasencia JM, Calvo-Temprano D, Sanchez M, Benegas M, Biosca M, Varona D, Vicente MA, Faez L, Solís MD, de la Haba I, Antonio M, Madridano O, Castañon E, Martinez MJ, Marchena P, Ramchandani A, Dominguez A, Puerta A, Martinez de la Haza D, Pueyo J, Hernandez S, Fernandez-Plaza A, Martinez-Encarnacion L, Martin M, Marin G, Ayala F, Vicente V, and Otero R

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Cohort Studies, Female, Hemorrhage epidemiology, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Risk Assessment, Risk Factors, Spain epidemiology, Time Factors, Tomography, X-Ray Computed, Young Adult, Neoplasms complications, Neoplasms mortality, Pulmonary Embolism diagnostic imaging, Pulmonary Embolism epidemiology, Venous Thromboembolism diagnostic imaging, Venous Thromboembolism epidemiology
Abstract

The study aimed to identify predictors of overall 30-day mortality in cancer patients with pulmonary embolism including suspected pulmonary embolism (SPE) and unsuspected pulmonary embolism (UPE) events. Secondary outcomes included 30- and 90-day major bleeding and venous thromboembolism (VTE) recurrence.The study cohort included 1033 consecutive patients with pulmonary embolism from the multicentre observational ambispective EPIPHANY study (March 2006-October 2014). A subgroup of 497 patients prospectively assessed for the study were subclassified into three work-up scenarios (SPE, truly asymptomatic UPE and UPE with symptoms) to assess outcomes.The overall 30-day mortality rate was 14%. The following variables were associated with the overall 30-day mortality on multivariate analysis: VTE history, upper gastrointestinal cancers, metastatic disease, cancer progression, performance status, arterial hypotension <100 mmHg, heart rate >110 beats·min -1 , basal oxygen saturation <90% and SPE (versus overall UPE).The overall 30-day mortality was significantly lower in patients with truly asymptomatic UPE events (3%) compared with those with UPE-S (20%) and SPE (21%) (p<0.0001). Thirty- and 90-day VTE recurrence and major bleeding rates were similar in all the groups.In conclusion, variables associated with the severity of cancer and pulmonary embolism were associated with short-term mortality. Our findings may help to develop pulmonary embolism risk-assessment models in this setting., (Copyright ©ERS 2017.)

Published
2017
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2. Clinical features and short-term outcomes of cancer patients with suspected and unsuspected pulmonary embolism: the EPIPHANY study

Author

Font, Carme, Carmona-Bayonas, Alberto, Beato, Carmen, Reig, Oscar, Saez, Antonia, Jimenez-Fonseca, Paula, Plasencia, Juana M., Calvo-Temprano, David, Sanchez, Marcelo, Benegas, Mariana, Biosca, Mercedes, Varona, Diego, Angeles Vicente, Maria, Faez, Laura, del Pilar Solis, Maria, de la Haba, Irma, Antonio, Maite, Madridano, Olga, Castanon, Eduardo, Jose Martinez, Maria, Marchena, Pablo, Ramchandani, Avinash, Dominguez, Angel, Puerta, Alejandro, Martinez de la Haza, David, Pueyo, Jesus, Hernandez, Susana, Fernandez-Plaza, Angela, Martinez-Encarnacion, Lourdes, Martin, Mar, Marin, Gema, Ayala, Francisco, Vicente, Vicente, Otero, Remedios, Asociacion Invest Enfermedad Tromo, [Font, Carme] Hosp Clin Barcelona, Dept Med Oncol, IDIBAPS Translat Genom & Targeted Therapeut Solid, Villarroel 170, E-08036 Barcelona, Spain, [Reig, Oscar] Hosp Clin Barcelona, Dept Med Oncol, IDIBAPS Translat Genom & Targeted Therapeut Solid, Villarroel 170, E-08036 Barcelona, Spain, [Carmona-Bayonas, Alberto] Hosp Univ Morales Meseguer, Med Oncol & Hematol Dept, Murcia, Spain, [Angeles Vicente, Maria] Hosp Univ Morales Meseguer, Med Oncol & Hematol Dept, Murcia, Spain, [Ayala, Francisco] Hosp Univ Morales Meseguer, Med Oncol & Hematol Dept, Murcia, Spain, [Vicente, Vicente] Hosp Univ Morales Meseguer, Med Oncol & Hematol Dept, Murcia, Spain, [Beato, Carmen] Hosp Nisa Aljarafe, Dept Med Oncol, Seville, Spain, [Saez, Antonia] Axioma Comunicac, Dept Stat, Seville, Spain, [Jimenez-Fonseca, Paula] Hosp Univ Cent Asturias, Dept Med Oncol, Oviedo, Spain, [Faez, Laura] Hosp Univ Cent Asturias, Dept Med Oncol, Oviedo, Spain, [del Pilar Solis, Maria] Hosp Univ Cent Asturias, Dept Med Oncol, Oviedo, Spain, [Plasencia, Juana M.] Hosp Univ Morales Meseguer, Dept Radiol, Murcia, Spain, [Calvo-Temprano, David] Hosp Univ Cent Asturias, Dept Radiol, Oviedo, Spain, [Sanchez, Marcelo] Hosp Clin Barcelona, Radiodiagnost Dept, Barcelona, Spain, [Benegas, Mariana] Hosp Clin Barcelona, Radiodiagnost Dept, Barcelona, Spain, [Biosca, Mercedes] Hosp Univ Vall Hebron, Dept Med Oncol, Barcelona, Spain, [Varona, Diego] Hosp Univ Vall Hebron, Dept Radiol, Barcelona, Spain, [de la Haba, Irma] Hosp Llobregat, Hosp Duran & Reynals, Inst Catalad Oncol, Dept Med Oncol, Barcelona, Spain, [Antonio, Maite] Hosp Llobregat, Hosp Duran & Reynals, Inst Catalad Oncol, Dept Med Oncol, Barcelona, Spain, [Madridano, Olga] Hosp Infanta Sof San Sebastian Ios Reves, Dept Internal Med, Madrid, Spain, [Martin, Mar] Hosp Infanta Sof San Sebastian Ios Reves, Dept Internal Med, Madrid, Spain, [Castanon, Eduardo] Univ Navarra Clin, Dept Med Oncol, Pamplona, Spain, [Jose Martinez, Maria] Hosp Santa Lucia, Dept Med Oncol, Murcia, Spain, [Marchena, Pablo] Hosp San Juan Dios, Dept Internal Med, Esplugues Llobregat, Barcelona, Spain, [Ramchandani, Avinash] Hosp Insular Gran Canaria, Dept Med Oncol, Las Palmas Gran Canaria, Spain, [Dominguez, Angel] Hosp Nisa Aljarafe, Dept Radiol, Seville, Spain, [Puerta, Alejandro] Hosp Reina Sofia, Dept Radiol, Murcia, Spain, [Martinez de la Haza, David] Hosp Llobregat, Hosp Duran & Reynals, Inst Catalad Oncol, Dept Radiol, Barcelona, Spain, [Pueyo, Jesus] Univ Navarra Clin, Dept Radiol, Pamplona, Spain, [Hernandez, Susana] Hosp Infanta Sofia San Sebastian los Reves, Dept Radiol, Madrid, Spain, [Fernandez-Plaza, Angela] Hosp Santa Lucia, Dept Radiol, Murcia, Spain, [Martinez-Encarnacion, Lourdes] Hosp Santa Lucia, Dept Radiol, Murcia, Spain, [Marin, Gema] Hosp Clin Univ Virgen la Arrixaca, Dept Med Oncol, Murcia, Spain, [Otero, Remedios] HUVR IBiS, CIBERES, Dept Pneumol, Seville, Spain, and LEO Pharma Spain

Subjects
Male, Time Factors, 030204 cardiovascular system & hematology, Cohort Studies, 0302 clinical medicine, Risk Factors, Neoplasms, Diagnosis, Young adult, Aged, 80 and over, Adversely impact survival, Mortality rate, Venous Thromboembolism, Middle Aged, Pulmonary embolism, 030220 oncology & carcinogenesis, Cohort, Female, medicine.symptom, Cohort study, Venous thromboembolism, Pulmonary and Respiratory Medicine, Adult, Risk, medicine.medical_specialty, Adolescent, Hemorrhage, Guidelines, Asymptomatic, Risk Assessment, 03 medical and health sciences, Young Adult, Internal medicine, medicine, Humans, Aged, Performance status, business.industry, Outpatient management, Severity index, Cancer, medicine.disease, Surgery, Logistic Models, Spain, Multivariate Analysis, business, Pulmonary Embolism, Tomography, X-Ray Computed, Prognostic model
Abstract

The study aimed to identify predictors of overall 30-day mortality in cancer patients with pulmonary embolism including suspected pulmonary embolism (SPE) and unsuspected pulmonary embolism (UPE) events. Secondary outcomes included 30- and 90-day major bleeding and venous thromboembolism (VTE) recurrence.The study cohort included 1033 consecutive patients with pulmonary embolism from the multicentre observational ambispective EPIPHANY study (March 2006–October 2014). A subgroup of 497 patients prospectively assessed for the study were subclassified into three work-up scenarios (SPE, truly asymptomatic UPE and UPE with symptoms) to assess outcomes.The overall 30-day mortality rate was 14%. The following variables were associated with the overall 30-day mortality on multivariate analysis: VTE history, upper gastrointestinal cancers, metastatic disease, cancer progression, performance status, arterial hypotension 110 beats·min−1, basal oxygen saturation versus overall UPE).The overall 30-day mortality was significantly lower in patients with truly asymptomatic UPE events (3%) compared with those with UPE-S (20%) and SPE (21%) (pIn conclusion, variables associated with the severity of cancer and pulmonary embolism were associated with short-term mortality. Our findings may help to develop pulmonary embolism risk-assessment models in this setting.

Published
2017

3. Prognostic value of computed tomography pulmonary angiography indices in patients with cancer-related pulmonary embolism: Data from a multicenter cohort study

Author

Alejandro Puerta, Remedios Otero, Juana María Plasencia-Martínez, Mari José Martínez, Carme Font, Angela Fernandez-Plaza, Lourdes Martinez-Encarnacion, Gema Marín, M. Martín, Carmen Beato, Marcelo Sánchez, L. Faez, Avinash Ramchandani, Jesus Pueyo, Paula Jiménez-Fonseca, D. Calvo-Temprano, Irma de al Haba, M. Antonio, Daniel Rodríguez, Diego Varona, O. Madridano, Susana Hernández-Muñiz, Alberto Carmona-Bayonas, Manuel Sánchez-Cánovas, Merce Biosca, Pilar Solís, Fernando Sánchez-Lasheras, David Martinez de la Haza, Ángel Domínguez, M.A. Vicente, Mariana Benegas, Francisco J. Fenoy, Pablo Javier Marchena, Vicente Vicente, and Eduardo Castanon

Subjects
Adult, Male, medicine.medical_specialty, Computed Tomography Angiography, Heart Ventricles, Ventricular Dysfunction, Right, Pulmonary embolism, 030204 cardiovascular system & hematology, Pulmonary Artery, Inferior vena cava, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, medicine.artery, Internal medicine, Hounsfield scale, Neoplasms, Ascending aorta, medicine, Pulmonary angiography, Humans, Radiology, Nuclear Medicine and imaging, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Prognosis, Reproducibility of Results, General Medicine, Middle Aged, medicine.disease, medicine.vein, Pulmonary artery, Right ventricular dysfunction, Cardiology, Tumor, Multidetector computed tomography, Female, Radiology, business, Pulmonary Embolism, Cohort study
Abstract

OBJECTIVE: To analyze the prognostic value of pulmonary artery obstruction versus right-ventricle (RV) dysfunction radiologic indices in cancer-related pulmonary embolism (PE). METHODS: We enrolled 303 consecutive patients with paraneoplastic PE, evaluated by computed tomography pulmonary angiography (CTPA) between 2013 and 2014. The primary outcome measure was serious complications at 15days. Multivariate analyses were conducted by using binary logistic and robust regressions. Radiological features such as the Qanadli index (QI) and RV dysfunction signs were analyzed with Spearman's partial rank correlations. RESULTS: RV diameter was the only radiological variable associated with an adverse outcome. Subjects with enlarged RV (diameter>45mm) had more 15-day complications (58% versus 40%, p=0.001). The QI correlated with the RV diameter (r=0.28, p

Published
2016

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