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Borg scale detected wellbeing respiratory sensation (0<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>absolute wellbeing, no symptoms, 10<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>maximum perceived feeling of discomfort).</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">PCEF indicates peak cough expiratory flow</span>; SpO2, <span class="elsevierStyleItalic">oxygen saturation as measured by pulse oxymetry</span>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Paneroni, D. Trainini, J.C. Winck, M. Vitacca" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Paneroni" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Trainini" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Winck" ] 3 => array:2 [ "nombre" => "M." 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García-Sanz, C. Pena-Álvarez, P. López-Landeiro, A. Bermo-Domínguez, T. Fontúrbel, F.J. González-Barcala" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M.T." "apellidos" => "García-Sanz" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Pena-Álvarez" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "López-Landeiro" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Bermo-Domínguez" ] 4 => array:2 [ "nombre" => "T." "apellidos" => "Fontúrbel" ] 5 => array:2 [ "nombre" => "F.J." "apellidos" => "González-Barcala" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215913001608?idApp=UINPBA00004E" "url" => "/08732159/0000002000000004/v2_201509071023/S0873215913001608/v2_201509071023/en/main.assets" ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "What is the clinical significance of isolated subsegmental pulmonary embolism?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "179" "paginaFinal" => "180" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "M.A. Gómez-Sánchez" "autores" => array:1 [ 0 => array:3 [ "nombre" => "M.A." "apellidos" => "Gómez-Sánchez" "email" => array:1 [ 0 => "mgomezsanchez@salud.madrid.org" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Cardiology Service, Hospital Universitario 12 de Octubre, CIBERES, Madrid, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Qual a revelância clínica da embolia pulmonar subsegmentar isolada?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In this original article, Garcia-Sanz et al. assess survival prognosis in a group of patients diagnosed with pulmonary embolism (PE) by chest computed tomography (CT). The study included 313 PE patients, 56% were women and the median age was 70 years old. The objective was to describe the clinical profile of patients with PE and to analyze their prognosis based on the extent of the disease.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The epidemiology of PE is difficult to determine because it can be asymptomatic or result in sudden death. Only a very small percentage of fatal cases are diagnosed while the patient is alive. PE is a major cause of morbidity and mortality in developed countries.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Since the incidence of deep venous thrombosis (DVT) increases with age, it is expected that more cases of PE will be diagnosed in the future.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Within the study group, 22% of patients had been diagnosed with cancer prior to PE. Although venous thromboembolism (VTE) is considered a consequence of the interaction between persistent risk factors and the temporal trigger factors, cancer remains an important risk factor for all-cause mortality after episodes of VTE. In the present study no significant difference was found between the presence of cancer and the extent of disease. Dyspnea was the most common symptom in patients with central PE (68% of cases) and pain was also a common symptom in segmental and subsegmental PE (25% and 7%, respectively). PE patients frequently present with chest pain which is usually caused by pleural irritation due to distal embolisms, causing pulmonary infarction.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Rapid onset of dyspnea is usually due to central PE and may be associated with angina-like pain reflecting right ventricle ischemia.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The authors report that subsegmental PE accounted for 7% of cases; these patients were younger, had lower comorbidity and none of them presented proximal deep venous thrombosis (DVT). This contrasts with the reported presence of DVT in 70% of patients with proven PE.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">This calls into question the clinical significance of isolated subsegmental PE on CT. This finding was present in 9.4% of those who underwent a CT.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The positive value is low and an interobserver variation is high at subsegmental level.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In this situation, is advisable to perform compression venous ultrasonography to ensure that the patients does not have DVT that it should be treated. This echography assessment showed DVT in 30–50% of patients with PE.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The incidental finding of clinically unsuspected PE on CT is a growing problem, that occurs in 1–2% of thoracic CT examinations, more often in patients with cancer, but also in patients with heart failure or atrial fibrillation.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> Additional testing may be needed to confirm PE in case of isolated subsegmental thrombi.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The authors reported a 30 days mortality rate of 7%, attributable to PE in 3.5% of cases. None of the patients died as a result of subsegmental PE. They also found that factors independently related to a higher likelihood of mortality were cancer diagnosis and higher comorbidity. In the Spanish registry RIETE, immobility due to neurological involvement, presence of cancer and old age were independently correlated with increased short-term mortality, following an episode of VTE.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">It is an accepted fact that acute right ventricular failure is a major determinant to predict prognosis after acute episode of PE. The presence of sustained arterial hypotension and cardiogenic shock is indicative of poor prognosis in the short term follow-up. García Sanz et al. do not provide information on the distribution of high-risk patients in relation to the extent of PE and the influence it could have on RV failure in the short-term prognosis. Possibly this is inherent in the design of the study – a retrospective design and single center – one of the major limitations.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The authors discuss the uncertain clinical significance of subsegmental PE, suggesting that the prognosis is associated more with the presence of accompanying disorders than the extent of the disease.Although there have been many advances in the management of PE, a number of justifiable doubts persist.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In a patient with isolated subsegmental PE without proximal DVT, anticoagulation decision should be based on a balance between the risk of bleeding and diagnostic probability.The original article under this editorial brings additional experience and helps us to individualize decisions.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Symptoms, location and prognosis of pulmonary embolism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.T. 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Year/Month | Html | Total | |
---|---|---|---|
2024 November | 12 | 10 | 22 |
2024 October | 71 | 32 | 103 |
2024 September | 164 | 25 | 189 |
2024 August | 134 | 31 | 165 |
2024 July | 175 | 32 | 207 |
2024 June | 106 | 25 | 131 |
2024 May | 137 | 36 | 173 |
2024 April | 104 | 28 | 132 |
2024 March | 99 | 24 | 123 |
2024 February | 112 | 23 | 135 |
2024 January | 129 | 29 | 158 |
2023 December | 109 | 27 | 136 |
2023 November | 113 | 38 | 151 |
2023 October | 100 | 38 | 138 |
2023 September | 96 | 32 | 128 |
2023 August | 76 | 23 | 99 |
2023 July | 98 | 25 | 123 |
2023 June | 126 | 19 | 145 |
2023 May | 114 | 29 | 143 |
2023 April | 93 | 20 | 113 |
2023 March | 124 | 24 | 148 |
2023 February | 96 | 29 | 125 |
2023 January | 79 | 22 | 101 |
2022 December | 110 | 15 | 125 |
2022 November | 101 | 37 | 138 |
2022 October | 98 | 41 | 139 |
2022 September | 113 | 22 | 135 |
2022 August | 99 | 37 | 136 |
2022 July | 67 | 44 | 111 |
2022 June | 48 | 26 | 74 |
2022 May | 86 | 69 | 155 |
2022 April | 58 | 42 | 100 |
2022 March | 64 | 37 | 101 |
2022 February | 52 | 29 | 81 |
2022 January | 69 | 33 | 102 |
2021 December | 40 | 41 | 81 |
2021 November | 62 | 42 | 104 |
2021 October | 57 | 45 | 102 |
2021 September | 46 | 35 | 81 |
2021 August | 62 | 14 | 76 |
2021 July | 57 | 24 | 81 |
2021 June | 88 | 25 | 113 |
2021 May | 123 | 22 | 145 |
2021 April | 195 | 75 | 270 |
2021 March | 169 | 16 | 185 |
2021 February | 115 | 18 | 133 |
2021 January | 97 | 14 | 111 |
2020 December | 69 | 14 | 83 |
2020 November | 113 | 16 | 129 |
2020 October | 62 | 27 | 89 |
2020 September | 89 | 27 | 116 |
2020 August | 86 | 20 | 106 |
2020 July | 136 | 25 | 161 |
2020 June | 103 | 13 | 116 |
2020 May | 113 | 23 | 136 |
2020 April | 103 | 10 | 113 |
2020 March | 92 | 16 | 108 |
2020 February | 116 | 20 | 136 |
2020 January | 139 | 19 | 158 |
2019 December | 111 | 22 | 133 |
2019 November | 119 | 14 | 133 |
2019 October | 118 | 28 | 146 |
2019 September | 89 | 23 | 112 |
2019 August | 164 | 14 | 178 |
2019 July | 203 | 27 | 230 |
2019 June | 185 | 17 | 202 |
2019 May | 177 | 28 | 205 |
2019 April | 135 | 24 | 159 |
2019 March | 230 | 15 | 245 |
2019 February | 211 | 15 | 226 |
2019 January | 240 | 24 | 264 |
2018 December | 164 | 5 | 169 |
2018 November | 53 | 4 | 57 |
2018 October | 47 | 8 | 55 |
2018 September | 26 | 5 | 31 |
2018 August | 45 | 21 | 66 |
2018 July | 69 | 20 | 89 |
2018 June | 76 | 16 | 92 |
2018 May | 90 | 15 | 105 |
2018 April | 108 | 28 | 136 |
2018 March | 85 | 7 | 92 |
2018 February | 55 | 11 | 66 |
2018 January | 77 | 11 | 88 |
2017 December | 90 | 23 | 113 |
2017 November | 57 | 21 | 78 |
2017 October | 29 | 19 | 48 |
2017 September | 38 | 13 | 51 |
2017 August | 24 | 21 | 45 |
2017 July | 22 | 8 | 30 |
2017 June | 36 | 10 | 46 |
2017 May | 34 | 13 | 47 |
2017 April | 7 | 7 | 14 |
2017 March | 10 | 8 | 18 |
2017 February | 10 | 4 | 14 |
2017 January | 16 | 4 | 20 |
2016 December | 14 | 4 | 18 |
2016 November | 10 | 5 | 15 |
2016 October | 11 | 7 | 18 |
2016 September | 10 | 1 | 11 |
2016 August | 11 | 7 | 18 |
2016 July | 6 | 6 | 12 |
2016 June | 0 | 6 | 6 |
2016 April | 161 | 3 | 164 |
2016 March | 230 | 21 | 251 |
2016 February | 212 | 16 | 228 |
2016 January | 214 | 19 | 233 |
2015 December | 141 | 19 | 160 |
2015 November | 119 | 14 | 133 |
2015 October | 131 | 9 | 140 |
2015 September | 117 | 17 | 134 |
2015 August | 110 | 13 | 123 |
2015 July | 114 | 8 | 122 |
2015 June | 67 | 11 | 78 |
2015 May | 84 | 6 | 90 |
2015 April | 103 | 18 | 121 |
2015 March | 108 | 10 | 118 |
2015 February | 106 | 17 | 123 |
2015 January | 101 | 20 | 121 |
2014 December | 116 | 13 | 129 |
2014 November | 95 | 16 | 111 |
2014 October | 108 | 35 | 143 |
2014 September | 88 | 18 | 106 |
2014 August | 111 | 34 | 145 |
2014 July | 93 | 61 | 154 |