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Phenotyping of non-high-risk acute pulmonary embolism patients: different initial manifestations of clinical deterioration

  • Yizhuo Gao
    Affiliations
    Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, China
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  • Na Wang
    Affiliations
    Occupational Disease and Occupational Health Prevention and Control Institute, Liaoning Center for Disease Control and Prevention, Shenyang, Liaoning, China
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  • Yuhua Li
    Affiliations
    Department of Emergency Medicine, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, China
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  • Haofeng Huang
    Affiliations
    Department of Emergency Medicine, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, China
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  • Dong Jia
    Correspondence
    Corresponding author: Dr. Dong Jia, Department of Emergency Medicine, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, China.
    Affiliations
    Department of Emergency Medicine, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, China
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      The outcomes of acute pulmonary embolism (PE) are quite heterogeneous, and it presents with non-specific symptoms of variable severity. While some patients have mild symptoms and PE is diagnosed coincidentally, other patients may present with right ventricular (RV) dysfunction or experience rapid deterioration that can lead to sudden death [
      • Chaudhury P
      • Gadre SK
      • Schneider E
      • Renapurkar RD
      • Gomes M
      • Haddadin I
      • et al.
      Impact of Multidisciplinary Pulmonary Embolism Response Team Availability on Management and Outcomes.
      ]. These outcomes are difficult to categorise. The prognostic heterogeneity of acute PE also exists for the initial manifestation of deterioration. Hemodynamic decompensation and respiratory distress are validated predictors of initial manifestations of clinical deterioration [
      • Konstantinides SV
      • Meyer G
      • Becattini C
      • Bueno H
      • Geersing GJ
      • Harjola VP
      • et al.
      2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS).
      ,
      • Santos AR
      • Freitas P
      • Ferreira J
      • Oliveira A
      • Goncalves M
      • Faria D
      • et al.
      Risk stratification in normotensive acute pulmonary embolism patients: focus on the intermediate-high risk subgroup.
      ], although it is unclear whether each manifestation is linked to some specific characteristic. This heterogeneity is likely related to differences in the pulmonary arteries (PAs), thrombus, and right/left heart that contribute to the pathophysiology of acute PE [
      • Pinsky MR.
      The right ventricle: interaction with the pulmonary circulation.
      ]. Therefore, given the number of potentially contributing factors, it is difficult to analyse this heterogeneity in the prognosis of acute PE.

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