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11. Chronic thromboembolic pulmonary hypertension and impairment after pulmonary embolism

Author

Valerio, L., Mavromanoli, A.C., Barco, S., Abele, C., Becker, D., Bruch, L., Ewert, R., Faehling, M., Fistera, D., Gerhardt, F., Ghofrani, H.A., Grgic, A., Grunig, E., Halank, M., Held, M., Hobohm, L., Hoeper, M.M., Klok, F.A., Lankeit, M., Leuchte, H.H., Martin, N., Mayer, E., Meyer, F.J., Neurohr, C., Opitz, C., Schmidt, K.H., Seyfarth, H.J., Wachter, R., Wilkens, H., Wild, P.S., Konstantinides, S.V., Rosenkranz, S., and FOCUS Investigators

Subjects
Adult, Male, Hypertension, Pulmonary, Follow-up, Pulmonary embolism, Medizin, Chronic thromboembolic pulmonary hypertension, Middle Aged, Functional impairment, Risk Factors, Acute Disease, Chronic Disease, Quality of Life, Humans, Female, Prospective Studies, Cardiology and Cardiovascular Medicine
Abstract

Aims To systematically assess late outcomes of acute pulmonary embolism (PE) and to investigate the clinical implications of post-PE impairment (PPEI) fulfilling prospectively defined criteria. Methods and results A prospective multicentre observational cohort study was conducted in 17 large-volume centres across Germany. Adult consecutive patients with confirmed acute symptomatic PE were followed with a standardized assessment plan and pre-defined visits at 3, 12, and 24 months. The co-primary outcomes were (i) diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH), and (ii) PPEI, a combination of persistent or worsening clinical, functional, biochemical, and imaging parameters during follow-up. A total of 1017 patients (45% women, median age 64 years) were included in the primary analysis. They were followed for a median duration of 732 days after PE diagnosis. The CTEPH was diagnosed in 16 (1.6%) patients, after a median of 129 days; the estimated 2-year cumulative incidence was 2.3% (1.2–4.4%). Overall, 880 patients were evaluable for PPEI; the 2-year cumulative incidence was 16.0% (95% confidence interval 12.8–20.8%). The PPEI helped to identify 15 of the 16 patients diagnosed with CTEPH during follow-up (hazard ratio for CTEPH vs. no CTEPH 393; 95% confidence interval 73–2119). Patients with PPEI had a higher risk of re-hospitalization and death as well as worse quality of life compared with those without PPEI. Conclusion In this prospective study, the cumulative 2-year incidence of CTEPH was 2.3%, but PPEI diagnosed by standardized criteria was frequent. Our findings support systematic follow-up of patients after acute PE and may help to optimize guideline recommendations and algorithms for post-PE care.

Published
2022

14. Quality of life 3 and 12 months following acute pulmonary embolism analysis from a prospective multicenter cohort study

Author

Valerio, L., Barco, S., Jankowski, M., Rosenkranz, S., Lankeit, M., Held, M., Gerhardt, F., Bruch, L., Ewert, R., Faehling, M., Freise, J., Ghofrani, H.A., Grunig, E., Halank, M., Hoeper, M.M., Klok, F.A., Leuchte, H.H., Mayer, E., Meyer, F.J., Neurohr, C., Opitz, C., Schmidt, K.H., Seyfarth, H.J., Trudzinski, F., Wachter, R., Wilkens, H., Wild, P.S., and Konstantinides, S.V.

Subjects
Male, Time Factors, pulmonary embolism, Middle Aged, Prognosis, humanities, Survival Rate, quality of life, 5D-5L, patient-reported outcomes, Germany, Surveys and Questionnaires, patient-centered outcomes, PeMB-QoL, Acute Disease, Humans, Female, Prospective Studies, VTE, Aged, Follow-Up Studies
Abstract

Few data are available on the long-term course and predictors of quality of life (QoL) following acute pulmonary embolism (PE).What are the kinetics and determinants of disease-specific and generic health-related QoL 3 and 12 months following an acute PE?The Follow-up after Acute Pulmonary Embolism (FOCUS) study prospectively followed up consecutive adult patients with objectively diagnosed PE. Patients were considered for study who completed the Pulmonary Embolism Quality of Life (PEmb-QoL) questionnaire at predefined visits 3 and 12 months following PE. The course of disease-specific QoL as assessed using the PEmb-QoL and the impact of baseline characteristics using multivariable mixed effects linear regression were studied; also assessed was the course of generic QoL as evaluated by using the EuroQoL Group 5-Dimension 5-Level utility index and the EuroQoL Visual Analog Scale.In 620 patients (44% women; median age, 62 years), overall disease-specific QoL improved from 3 to 12 months, with a decrease in the median PEmb-QoL score from 19.4% to 13.0% and a mean individual change of -4.3% (95% CI, -3.2 to -5.5). Female sex, cardiopulmonary disease, and higher BMI were associated with worse QoL at both 3 and 12 months. Over time, the association with BMI became weaker, whereas older age and previous VTE were associated with worsening QoL. Generic QoL also improved: the mean ± SD EuroQoL Group 5-Dimension 5-Level utility index increased from 0.85 ± 0.22 to 0.87 ± 0.20 and the visual analog scale from 72.9 ± 18.8 to 74.4 ± 19.1.In a large cohort of survivors of acute PE, the change of QoL was quantified between months 3 and 12 following diagnosis, and factors independently associated with lower QoL and slower recovery of QoL were identified. This information may facilitate the planning and interpretation of clinical trials assessing QoL and help guide patient management.German Clinical Trials Registry (Deutsches Register Klinischer Studien: www.drks.de); No.: DRKS00005939.

Published
2021

16. Uncertain value of high-sensitive troponin T for selecting patients with acute pulmonary embolism for outpatient treatment by hestia criteria

Author

Hendriks, S.V., Lankeit, M., Exter, P.L. den, Zondag, W., Brouwer, R., Eijsvogel, M., Grootenboers, M.J., Faber, L.M., Heller-Baan, R., Hofstee, H.M.A., Sol, A.I. del, Mairuhu, A.T.A., Melissant, C.F., Peltenburg, H.G., deRee, M.A. van, Serne, E.H., Konstantinides, S., Klok, F.A., Huisman, M.V., Vesta Investigators, Internal medicine, ACS - Diabetes & metabolism, and ACS - Microcirculation

Subjects
medicine.medical_specialty, business.industry, MEDLINE, General Medicine, medicine.disease, Research Letters, Pulmonary embolism, Internal medicine, High sensitivity troponin, Emergency Medicine, medicine, Cardiology, Research Letter, business, Value (mathematics)
Published
2020

17. Early discharge and home treatment of patients with low-risk pulmonary embolism with the oral factor Xa inhibitor rivaroxaban: an international multicentre single-arm clinical trial

Author

Schmidtmann, I. (Irene), Ageno, W. (Walter), Bauersachs, R.M. (Rupert M.), Becattini, C. (Cecilia), Bernardi, E. (Enrico), Beyer-Westendorf, J. (Jan), Bonacchini, L. (Luca), Brachmann, J. (Johannes), Christ, M. (Michael), Czihal, M. (Michael), Duerschmied, D. (Daniel), Empen, K. (Klaus), Espinola-Klein, C. (Christine), Ficker, J.H. (Joachim H.), Fonseca, C. (Candida), Genth-Zotz, S. (Sabine), Jiménez, D. (David), Harjola, V.P. (Veli-Pekka), Held, M. (Matthias), Iogna-Prat, L. (Lorenzo), Lange, T.J. (Tobias J.), Manolis, A. (Athanasios), Meyer, A. (Andreas), Mustonen, P. (Pirjo), Rauch-Kroehnert, U. (Ursula), Ruiz-Artacho, P. (Pedro), Schellong, S. (Sebastian), Schwaiblmair, M. (Martin), Stahrenberg, R. (Raoul), Westerweel, P.E. (Peter), Wild, P.S. (Philipp S.), Konstantinides, S.V. (Stavros V.), and Lankeit, M. (Mareike)

Subjects
Rivaroxaban, Pulmonary embolism, Home treatment, Management trial, Right ventricular dysfunction, Risk stratification
Abstract

Aims To investigate the efficacy and safety of early transition from hospital to ambulatory treatment in low-risk acute PE, using the oral factor Xa inhibitor rivaroxaban. Methods and results We conducted a prospective multicentre single-arm investigator initiated and academically sponsored management trial in patients with acute low-risk PE (EudraCT Identifier 2013-001657-28). Eligibility criteria included absence of (i) haemodynamic instability, (ii) right ventricular dysfunction or intracardiac thrombi, and (iii) serious comorbidities. Up to two nights of hospital stay were permitted. Rivaroxaban was given at the approved dose for PE for >_3 months. The primary outcome was symptomatic recurrent venous thromboembolism (VTE) or PE-related death within 3 months of enrolment. An interim analysis was planned after the first 525 patients, with prespecified early termination of the study if the null hypothesis could be rejected at the level of a = 0.004 (

Published
2020

18. Genetic findings in patients with different forms of pulmonary hypertension

Author

Eichstaedt, C., Sassmannshausen, Z., Gall, H., Seyfarth, H. J., Lerche, M., Halank, M., Xanthouli, P., Harutyunova, S., Egenlauf, B., Milger, K., Rosenkranz, S., Ewert, R., Lankeit, M., Lange, T., Hinderhofer, K., Gruenig, E., Eichstaedt, C., Sassmannshausen, Z., Gall, H., Seyfarth, H. J., Lerche, M., Halank, M., Xanthouli, P., Harutyunova, S., Egenlauf, B., Milger, K., Rosenkranz, S., Ewert, R., Lankeit, M., Lange, T., Hinderhofer, K., and Gruenig, E.

Published
2020

21. Quality of life 3 and 12 months after acute pulmonary embolism: analysis of 617 patients from the prospective multicentre FOCUS study

Author

Valerio, L, primary, Barco, S, additional, Jankowski, M, additional, Rosenkranz, S, additional, Lankeit, M, additional, Held, M, additional, Gerhardt, F, additional, Bruch, L, additional, Ewert, R, additional, Faehling, M, additional, Freise, J, additional, Ardeschir Ghofrani, H, additional, Gruenig, E, additional, Halank, M, additional, and Konstantinides, S.V, additional

Published
2020
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27. Genetic findings in patients with different forms of pulmonary hypertension

Author

Eichstaedt, C, additional, Saßmannshausen, Z, additional, Gall, H, additional, Seyfarth, HJ, additional, Lerche, M, additional, Halank, M, additional, Xanthouli, P, additional, Harutyunova, S, additional, Egenlauf, B, additional, Milger, K, additional, Rosenkranz, S, additional, Ewert, R, additional, Lankeit, M, additional, Lange, TJ, additional, Hinderhofer, K, additional, and Grünig, E, additional

Published
2020
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33. Akute Lungenembolie

Author

Grothusen, C., primary, Lankeit, M., additional, Olsson, K., additional, Panholzer, B., additional, Haneya, A., additional, and Cremer, J., additional

Published
2019
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34. Erratum: 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism (European Heart Journal (2014) 35 (3033-73) DOI 10.1093/eurheartj/ehu283

Author

Konstantinides, S. V., Torbicki, A., Agnelli, G., Danchin, N., Fitzmaurice, D., Galiè, N., Gibbs, Jsr, Huisman, Mv, Humbert, M., Kucher, N., Lang, I., Lankeit, M., Lekakis, J., Maack, C., Mayer, E., Meneveau, N., Perrier, A., Pruszczyk, P., Rasmussen, Lh, Schindler, Th, Svitil, P., Vonk Noordegraaf, A., Zamorano, J. L., Zompatori, M., Konstantinides, S.V., Torbicki, A, Agnelli, G, Danchin, N, Fitzmaurice, D, Galiè, N, Gibbs, Jsr, Huisman, Mv, Humbert, M, Kucher, N, Lang, I, Lankeit, M, Lekakis, J, Maack, C, Mayer, E, Meneveau, N, Perrier, A, Pruszczyk, P, Rasmussen, Lh, Schindler, Th, Svitil, P, Vonk Noordegraaf, A, Zamorano, J.L., Zompatori, M, Rasmussen, L.H., Schindler, T.H., Pulmonary medicine, ICaR - Heartfailure and pulmonary arterial hypertension, and ICaR - Ischemia and repair

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Modification of recommendations

Published
2015

35. Atrial fibrillation is frequent but does not affect risk stratification in pulmonary embolism.

Author

Ebner, M., Rogge, N. I. J., Parwani, A. S., Sentler, C., Lerchbaumer, M. H., Pieske, B., Konstantinides, S. V., Hasenfuß, G., Wachter, R., and Lankeit, M.

Subjects
ATRIAL fibrillation, PULMONARY embolism, LOGISTIC regression analysis, HOSPITAL mortality, COMORBIDITY
Abstract

Background: Although prior studies indicate a high prevalence of atrial fibrillation (AF) in patients with pulmonary embolism (PE), the exact prevalence and prognostic impact are unknown.Methods: We aimed to investigate the prevalence, risk factors and prognostic impact of AF on risk stratification, in-hospital adverse outcomes and mortality in 528 consecutive PE patients enrolled in a single-centre registry between 09/2008 and 09/2017.Results: Overall, 52 patients (9.8%) had known AF and 57 (10.8%) presented with AF on admission; of those, 34 (59.6%) were newly diagnosed with AF. Compared to patients with no AF, overt hyperthyroidism was associated with newly diagnosed AF (OR 7.89 [2.99-20.86]), whilst cardiovascular risk comorbidities were more frequently observed in patients with known AF. Patients with AF on admission had more comorbidities, presented more frequently with tachycardia and elevated cardiac biomarkers and were hence stratified to higher risk classes. However, AF on admission had no impact on in-hospital adverse outcome (8.3%) and in-hospital mortality (4.5%). In multivariate logistic regression analyses corrected for AF on admission, NT-proBNP and troponin elevation as well as higher risk classes in risk assessment models remained independent predictors of an in-hospital adverse outcome.Conclusion: Atrial fibrillation is a frequent finding in PE, affecting more than 10% of patients. However, AF was not associated with a higher risk of in-hospital adverse outcomes and did not affect the prognostic performance of risk assessment strategies. Thus, our data support the use of risk stratification tools for patients with acute PE irrespective of the heart rhythm on admission. [ABSTRACT FROM AUTHOR]

Published
2020
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41. 2163Predicting in-hospital major bleeding in pulmonary embolism patients treated with systemic thrombolytic therapy

Author

Kresoja, K.-P, primary, Meneveau, N, additional, Jimenez, D, additional, Sanchez, O, additional, Becattini, C, additional, Spillmann, F, additional, Sobkowicz, B, additional, Vanni, S, additional, Konstantinides, S, additional, Kurzyna, M, additional, Pruszczyk, P, additional, Wilkens, H, additional, Bova, C, additional, Meyer, G, additional, and Lankeit, M, additional

Published
2018
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43. [Chronic thromboembolic pulmonary hypertension: Recommendations of the Cologne Consensus Conference 2016]

Author

Wilkens H, Konstantinides S, Lang I, Bunck AC, Gerges M, Gerhardt F, Grgic A, Grohé C, Guth S, Held M, Hinrichs J, Hoeper MM, Klepetko W, Kramm T, Krüger U, Lankeit M, Meyer BC, Olsson KM, Schäfers HJ, Schmidt M, Seyfarth HJ, Ulrich S, Wiedenroth CB, and Mayer E

Subjects
Fibrinolytic Agents, Hypertension, Pulmonary, Practice Guidelines as Topic, Cardiology, Pulmonary Medicine, Humans, Drug Therapy, Combination, Molecular Targeted Therapy, Pulmonary Embolism, Antihypertensive Agents
Abstract

The 2015 European Guidelines on Pulmonary Hypertension did not cover only pulmonary arterial hypertension (PAH), but also other significant subgroups of pulmonary hypertension (PH). In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany to discuss open and controversial issues surrounding the practical implementation of the European Guidelines. Several working groups were initiated, one of which was dedicated to the diagnosis and treatment of chronic thromboembolic pulmonary hypertension (CTEPH). In every patient with PH of unknown cause CTEPH should be excluded. The primary treatment option is surgical pulmonary endarterectomy (PEA) in a specialized multidisciplinary CTEPH center. Inoperable patients or patients with persistent or recurrent CTEPH after PEA are candidates for targeted drug therapy. For balloon pulmonary angioplasty (BPA), there is currently only limited experience. This option - as PEA - is reserved to specialized centers with expertise for this treatment method. In addition, a brief overview is given on pulmonary artery sarcoma, since its surgical treatment is often analogous to PEA. The recommendations of this working group are summarized in the present paper.

Published
2016

44. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)Endorsed by the European Respiratory Society (ERS)

Author

Konstantinides, S.V., Torbicki, A., Agnelli, G., Danchin, N., Fitzmaurice, D., Galie, N., Gibbs, J.S., Huisman, M.V., Humbert, M., Kucher, N., Lang, I., Lankeit, M., Lekakis, J., Maack, C., Mayer, E., Meneveau, N., Perrier, A., Pruszczyk, P., Rasmussen, L.H., Schindler, T.H., Svitil, P., Vonk-Noordegraaf, A., Zamorano, J.L., Zompatori, M., Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, Gibbs JS, Huisman MV, Humbert M, Kucher N, Lang I, Lankeit M, Lekakis J, Maack C, Mayer E, Meneveau N, Perrier A, Pruszczyk P, Rasmussen LH, Schindler TH, Svitil P, Vonk Noordegraaf A, Zamorano JL, Zompatori M, Pulmonary medicine, and ICaR - Heartfailure and pulmonary arterial hypertension

Subjects
PULMONARY EMBOLISM, thromboembolic pulmonary disease, COMPUTED TOMOGRAPHY
Abstract

New european guidelines regardin the diagnosis and management of acute pulmonary embolism

Published
2014

45. P4922Validation of the prognostic impact of copeptin in normotensive pulmonary embolism in a European multicentre study

Author

Hellenkamp, K., primary, Pruszczyk, P., additional, Jimenez, D., additional, Wyzgal, A., additional, Barrios, D., additional, Ciurzynski, M., additional, Morillo, R., additional, Hobohm, L., additional, Keller, K., additional, Kurnicka, K., additional, Kostrubiec, M., additional, Wachter, R., additional, Hasenfuss, G., additional, Konstantinides, S., additional, and Lankeit, M., additional

Published
2017
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