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Curso de Atualização em Medicina Cardiovascular 2019
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A. Basics
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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15. Valvular Heart Disease
16. Infective Endocarditis
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19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
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Comparison of different diagnostic models performance in patients with Covid-19 and pulmonary embolism
Session:
Posters (Sessão 4 - Écran 8) - Doença Arterial Pulmonar - Foco na Embolia Pulmonar
Speaker:
Joao Santos Fonseca
Congress:
CPC 2022
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.3 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Diagnostic Methods
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Joao Santos Fonseca; Beatriz Valente Silva; Pedro Silvério António; Sara Couto Pereira; Joana Brito; Pedro Alves da Silva; Ana Beatriz Garcia; Ana Margarida Martins; Catarina Simões de Oliveira; Carlos Mendonça; Luísa Urbano; Tiago Rodrigues; Cláudia Jorge; Rui Plácido; Fausto j. Pinto
Abstract
<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Arial"><span style="color:#000000"><span style="background-color:#ffffff"><strong>Introduction</strong></span></span></span></span><span style="font-size:10pt"><span style="font-family:Arial"><span style="color:#000000"><span style="background-color:#ffffff">: Pulmonary embolism (PE) is a common complication of SARS-CoV-2 infection. Several diagnostic prediction rules based on pretest probability and D-dimer have been validated in non-COVID patients, but it remains unclear whether they can be safely applied in COVID-19 patients. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Arial"><span style="color:#000000"><span style="background-color:#ffffff"><strong>Objective</strong></span></span></span></span><span style="font-size:10pt"><span style="font-family:Arial"><span style="color:#000000"><span style="background-color:#ffffff">: We aimed to compare the diagnostic accuracy of the standard approach based on Wells and Geneva scores combined with a standard D-dimer cut-off of 500 ng/ml with three alternative strategies (age-adjusted, YEARS and PEGeD algorithms) in COVID-19 patients.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Arial"><span style="color:#000000"><span style="background-color:#ffffff"><strong>Methods</strong></span></span></span></span><span style="font-size:10pt"><span style="font-family:Arial"><span style="color:#000000"><span style="background-color:#ffffff">: This retrospective study included all COVID-19 patients admitted to the Emergency Department (ED) who underwent computed tomography pulmonary angiography (CTPA) due to PE suspicion. The diagnostic prediction rules for PE were compared between patients with and without PE.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Arial"><span style="color:#000000"><span style="background-color:#ffffff"><strong>Results</strong></span></span></span></span><span style="font-size:10pt"><span style="font-family:Arial"><span style="color:#000000"><span style="background-color:#ffffff">: We included 300 patients and PE was confirmed in 15%. No differences were found regarding comorbidities, traditional risk factors for PE and signs and symptoms between patients with and without PE. Wells and Geneva scores showed no predictive value for PE occurrence, whether a standard or an age-adjusted cut-off was considered. YEARS and PEGeD algorithms were associated with increased specificity (19% CTPA reduction) but raising non-diagnosed PE. Despite elevated values in all patients, those with PE had higher D-dimer levels. However, incrementing thresholds to select patients for CTPA was also associated with a substantial decrease in sensitivity.</span></span></span></span></p> <p><span style="font-size:10pt"><span style="font-family:Arial"><span style="color:#000000"><span style="background-color:#ffffff"><strong>Conclusion</strong></span></span></span></span><span style="font-size:10pt"><span style="font-family:Arial"><span style="color:#000000"><span style="background-color:#ffffff">: None of the diagnostic prediction rules are reliable predictors of PE in COVID-19. Our data favour the use of a D-dimer threshold of 500 ng/ml, considering that higher thresholds increase specificity but limits this strategy as a screening test.</span></span></span></span></p>
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