In this study, we investigated the mechanism underlying electrocardiogram (ECG) alterations in a rabbit model of acute pulmonary thromboembolism (PTE). Twelve healthy adult New Zealand white rabbits were used, with eight in the experimental group (PTE group) and four in the control group. After developing the rabbit model of acute PTE, ECG and coronary angiography were performed. HE staining was conducted on the right and left ventricular tissues, and polymerase chain reaction (PCR) was used to determine brain natriuretic peptide (BNP), tumor necrosis factor-alpha (TNF-?), and Troponin I (TNI) mRNA expression in the myocardium. There were considerable changes in the ST segment of the ECG in the PTE group. Coronary angiography revealed the absence of spasm, stenosis, and occlusion. In the plasma of the PTE group, the levels of D-dimer, BNP, TNF-?, and TNI were significantly elevated, and these changes were statistically significant (P<0.05). PCR analysis of ventricular myocardial tissue indicated significantly higher levels of BNP, TNF-?, and TNI mRNA in the PTE group than in the control group. These differences were statistically significant (P<0.05). The ST-T variations on the ECG of rabbits with acute PTE correlate strongly with the temporary changes in right heart volume caused by acute PTE. Keywords: Animal model of pulmonary embolism, B-type natriuretic peptide, Electrocardiogram, Pulmonary thromboembolism, Troponin I, Tumor necrosis factor-alpha.
- MeSH
- akutní nemoc MeSH
- elektrokardiografie * MeSH
- králíci MeSH
- modely nemocí na zvířatech * MeSH
- natriuretický peptid typu B krev MeSH
- plicní embolie * patofyziologie krev MeSH
- TNF-alfa krev metabolismus genetika MeSH
- troponin I krev metabolismus MeSH
- zvířata MeSH
- Check Tag
- králíci MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND AND AIM: Assessment of appropriateness of CT pulmonary angiograms (CTPA) in patients with suspected pulmonary embolism (PE) is based on risk stratification algorithms such as simplified the Geneva Score (sGS) in combination with D-dimer blood tests. The aim of this study was to validate the diagnostic yield and appropriateness of CTPA examinations in accordance with 2014 European Society of Cardiology (ESC) guidelines. MATERIALS AND METHODS: Data from 155 outpatients who underwent CTPA for clinical suspicion of PE were gathered from the radiology information system (RIS) and the clinical information system (CIS). We assessed the presence of sGS items and D-dimer blood test results in RIS from CTPA request forms and from clinical documentation in CIS. RESULTS: Based on the RIS, there were 2.6% patients with high (sGS≥3) and 97.4% patients with low pre-test PE probability (sGS<3), and CTPA indication was formally comprehendible in 75.5% using sGS and D-dimer blood tests. Based on RIS and CIS data in combination, there were 41.3% patients with high and 58.7% patients with low pre-test PE probability, and CTPA indication was formally comprehendible in 88.4%. Using RIS and CIS in combination, PE probability was upgraded from low to high probability in 39.7% compared with RIS alone. In 12.9%, there was a lack of data in RIS for CTPA justification. CONCLUSION: There is a high diagnostic yield when applying current diagnostic guidelines to our data. There was however a notable discrepancy between the data transferred to the CTPA request forms from the full clinical documentation, therefore not readily available for clinical decision making.
- MeSH
- CT angiografie * MeSH
- fibrin-fibrinogen - produkty degradace analýza MeSH
- hodnocení rizik MeSH
- lidé středního věku MeSH
- lidé MeSH
- plicní embolie krev diagnostické zobrazování MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- validační studie MeSH
- MeSH
- antikoagulancia terapeutické užití MeSH
- biologické markery MeSH
- diagnostické zobrazování klasifikace MeSH
- fibrin-fibrinogen - produkty degradace analýza MeSH
- fibrinolytika aplikace a dávkování klasifikace MeSH
- hemodynamika MeSH
- kontraindikace MeSH
- lidé MeSH
- plicní embolie * diagnóza epidemiologie etiologie farmakoterapie komplikace krev patologie terapie MeSH
- plicní hypertenze diagnóza farmakoterapie terapie MeSH
- prognóza MeSH
- rizikové faktory MeSH
- stupeň závažnosti nemoci MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- Publikační typ
- směrnice pro lékařskou praxi MeSH
- MeSH
- diferenciální diagnóza MeSH
- dyspnoe epidemiologie etiologie MeSH
- fibrin-fibrinogen - produkty degradace analýza MeSH
- lidé MeSH
- plicní embolie * diagnóza epidemiologie krev MeSH
- prediktivní hodnota testů MeSH
- rizikové faktory MeSH
- synkopa epidemiologie etiologie MeSH
- urgentní zdravotnické služby metody MeSH
- Check Tag
- lidé MeSH
- MeSH
- diferenciální diagnóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory plic diagnostické zobrazování MeSH
- plicní embolie farmakoterapie krev mortalita MeSH
- pneumonie * diagnostické zobrazování farmakoterapie krev MeSH
- příznaky a symptomy ústrojí dýchacího MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Patients with pulmonary embolism (PE) may have symptomatic or asymptomatic concomitant deep vein thrombosis (DVT). The reported prevalence of PE-associated DVT is variable, and thus, the utility of routine testing is controversial. The aim of our study was to analyze the prevalence of DVT and the factors associated with proximal DVT/whole-leg DVT in patients with symptomatic PE. In 428 consecutive patients (mean age: 59 ± 16.4 years; 52.3% men), we performed clinical examination and complete bilateral compression ultrasound and ascertained medical history and risk factors for DVT/PE. χ2 and t tests were used. Deep vein thrombosis was found in 70.6%; proximal DVT in 49.5%. Sensitivity/specificity of DVT symptoms was 42.7%/93.7% for whole-leg DVT and 47.6%/83.3% for proximal DVT. Male gender significantly prevailed among those with whole-leg DVT and with proximal DVT (58.9% and 61.8%). Active malignancy was significantly more frequent in the patients with proximal DVT than without proximal DVT (10.4% vs 3.7%). In conclusion, the prevalence of PE-associated DVT is quite high but clinical diagnosis is unreliable. In our group, male gender and active malignancy were significantly associated with the presence of concomitant proximal DVT.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- plicní embolie * krev epidemiologie etiologie MeSH
- prevalence MeSH
- rizikové faktory MeSH
- senioři MeSH
- sexuální faktory MeSH
- žilní trombóza * krev komplikace epidemiologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Práce ověřuje odolnost imunochemických souprav pro stanovení D-dimeru k působení interferujících složek lidské plazmy. Testované turbidimetrické soupravy Diagnostica Stago STA LIATEST DDi a její nová verze STA LIATEST DDi Plus byly použity pro stanovení koncentrace D-dimeru ve vzorcích s potvrzenou přítomností interferujících složek. Jako referenční metoda sloužila imunoanalýza na pevné fázi s promývacím krokem a fluorimetrickou detekcí VIDAS? D-Dimer ExclusionTM. Ve skupině 12 vzorků s interferujícími složkami testovaných soupravou STA LIATEST DDi se falešná pozitivita vyskytla 12krát, v paralelní skupině testované soupravou STA LIATEST DDi Plus se falešná pozitivita vyskytla 4krát. Byla stanovena korelace obou turbidimetrických LIA metod. V intervalu koncentrací D-dimeru 70–12 000 μg/l – FEU bylo dosaženo korelačního koeficientu R2 = 0,9944. Pomocí kontrolních vzorků byla stanovena preciznost měření soupravy STA LIATEST DDi Plus v sérii i v čase. V sérii bylo dosaženo variačního koeficientu na normální hladině 7,38 % a na patologické hladině 1,61 %. Při testováním mezi sériemi bylo dosaženo variačního koeficientu na normální hladině 7,78 % a na patologické hladině 2,16 %. Soupravu je možno použít pro detekci D-dimeru až do 20 000 μg/l – FEU. STA LIATEST DDi Plus má prokazatelně vyšší odolnost proti vlivu interferujících složek než stávající souprava STA LIATEST DDi.
Two immunoturbidimetric D-dimer assays were tested in terms of their resistance to plasma interferents. The Diagnostica Stago products STA LIATEST DDi and its new version STA LIATEST D-Di Plus were used to detect D-dimer concentrations in samples with confirmed presence of interferents. A solid phase immunoassay with fluorimetric detection VIDAS? D-Dimer ExclusionTM was used as the reference method. In the group of 12 samples containing interferents false positivity was detected in all 12 cases during testing with the STA LIATEST DDi kit. Results using the STA LIATEST DDi Plus kit were falsely positive in 4 cases. A correlation study on plasma samples with a range of 70–12000 μg/l – FEU was carried out. The coefficient of correlation between both assays was R2 = 0.9944. Precision studies of STA LIATEST DDi Plus were performed with the control samples on normal and pathological level. Intra-assay precision (expressed as coefficient of variation) was 7.38% on normal and 1.61% on pathological D-dimer levels. Inter-assay coefficient of variation values were 7.78% on the normal and 2.16% on the pathological D-dimer levels. The working range of the D-dimer concentration of STA LIATEST DDi Plus is up to 20000 μg/l–FEU. An increased resistance of the STA LIATEST DDi Plus to interferents was demonstrated.
- Klíčová slova
- matricový efekt, imunochemická diagnostika, interferent,
- MeSH
- dospělí MeSH
- falešně pozitivní reakce MeSH
- fibrin-fibrinogen - produkty degradace * analýza MeSH
- imunoanalýza metody MeSH
- krevní plazma * chemie imunologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- nefelometrie a turbidimetrie MeSH
- plicní embolie krev MeSH
- reagenční diagnostické soupravy * MeSH
- referenční standardy MeSH
- senioři MeSH
- statistika jako téma MeSH
- žilní trombóza krev MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- hodnotící studie MeSH
- srovnávací studie MeSH
- MeSH
- akutní koronární syndrom diagnóza krev MeSH
- lidé MeSH
- natriuretické peptidy * fyziologie krev MeSH
- natriuretický peptid typu B krev MeSH
- peptidové fragmenty krev MeSH
- plicní embolie diagnóza krev MeSH
- srdeční selhání * diagnóza krev MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
BACKGROUND: The prognostic value of D-dimer testing in patients with acute pulmonary embolism (PE) has not been thoroughly studied. METHODS: We used the RIETE Registry data to assess the 90-day prognostic value of increased IL Test D-dimer levels at baseline in patients with PE, according to the presence or absence of cancer. RESULTS: As of May 2013, 3,283 patients with acute PE underwent D-dimer testing using IL Test D-dimer. Among 2,588 patients without cancer, those with D-dimer levels in the highest quartile had a higher rate of fatal PE (2.6% vs. 0.9%; p=0.002), fatal bleeding (1.1% vs. 0.3%; p=0.017) and all-cause death (9.1% vs. 4.4%; p<0.001) at 90 days compared with those with levels in the lowest quartiles. Among 695 patients with cancer, those with levels in the highest quartile had a similar rate of fatal PE or fatal bleeding but higher mortality (35% vs. 24%; p<0.01). On multivariate analysis, non-cancer patients with D-dimer levels in the highest quartile had an increased risk for fatal PE (odds ratio [OR]: 3.3; 95% CI: 1.6-6.6), fatal bleeding (OR: 4.3; 95% CI: 1.4-13.7) and all-cause death (OR: 2.1; 95% CI: 1.4-3.1) compared with patients with levels in the lowest quartiles. CONCLUSIONS: Non-cancer patients with acute PE and IL Test D-dimer levels in the highest quartile had an independently higher risk for fatal PE, fatal bleeding and all-cause death at 90 days than those with levels in the lowest quartiles. In patients with cancer, D-dimer levels failed to predict fatal PE or fatal bleeding.
- MeSH
- antikoagulancia terapeutické užití MeSH
- fibrin-fibrinogen - produkty degradace analýza metabolismus MeSH
- lidé MeSH
- nádory krev MeSH
- plicní embolie krev MeSH
- prognóza MeSH
- rizikové faktory MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
