Surrogate markers for Severe Pulmonary Embolism

严重肺栓塞的替代标志物

• 批准号: 6915497
• 负责人: JEFFREY A KLINE
• 金额: $ 38.04万
• 依托单位: CAROLINAS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-07-08 至 2008-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6915497
• 关键词: anticoagulants; antiphospholipid syndrome; biomarker; blood chemistry; blood pressure; cardiovascular disorder chemotherapy; cardiovascular disorder diagnosis; clinical research; coagulation factor V; diagnosis design /evaluation; diagnosis quality /standard; echocardiography; functional ability; gene mutation; genetic screening; homocysteine; human subject; miscellaneous oxidoreductase; outcomes research; oximetry; patient oriented research; prognosis; prothrombin; pulmonary circulation obstruction; sign /symptom; troponin

DESCRIPTION (provided by applicant): Echocardiography can help risk-stratify the severity of pulmonary embolism (PE) diagnosed in normotensive patients. However, because echocardiography is not uniformly available in U.S. hospitals, more accessible surrogate criteria are needed: to facilitate the immediate recognition of disabling PE in hemodynamically stable patients. Prior work by the Pi has led to the hypothesis that cardiopulmonary stress from severe PE can be recognized by abnormalities in vital signs, the 12- lead ECG and the serum troponin measurement. For this project, a screening instrument to rule out severe PE has been defined asthe combination of a shock index (pulse/systolic blood pressure) <0.8, a pulse oximetry reading >91 percent, a Daniel ECG score <8 points, and a troponin I <0.4 ng/mh The hypothesis of this project is that patients with a negative screening instrument will not have right ventricular (RV) strain on echocardiography and are at very low risk of death or cardiopulmonary disability from PE treated with standard: anticoagulation. The first specific aim of the project is to test the diagnostic accuracy of the proposed screening instrument, using RV strain on transthoracic echocardiography as the criterion standard. The second aim will compare the diagnostic accuracy of the screening instrument with echocardiography for the prediction of an adverse outcome from PE. Because the screening instrument may notpredict RV damage from recurrent or unresolved PE, the second hypothesis is that nonmalignant thrombophilic conditions will increase risk of an adverse outcomefrom PE. Accordingly, :the third aim will test if patients with PE complicated by an adverse outcome are more likely to have antiphospholipid antibodies, or factor V Leiden G1691A, prothrombin G20210A, methylenetetrahydrofolate reductase C677T mutations, or low red blood cell methylfolate or high :plasma homocysteine concentrations, compared with patients with PE and no adverse outcome. An adverse clinical outcome will include death or anoxic brain insult :within 30 :days of diagnosis, recurrent PE, or cardiopuimonary disability, determined six months after diagnosis. Cardiopulmonary disability will be defined by New York Heart Association functional class II or worse, a repeat transthoracic echocardiogram with persistent RV strain, and a six-minute walk distance less than 330 meters. This study will determine if criteria that are widely and immediately available in most hospitals can be used to risk-stratify severity of PE and to clarify the role of nonmalignant thrombophilias on the prognosis of PE.

描述（由申请人提供）：超声心动图可以帮助分层正常患者诊断出肺栓塞（PE）的严重程度。 但是，由于超声心动图在美国医院不一致，因此需要更容易获得的替代标准：促进立即识别血液动力学稳定患者中的PE。 PI的先前工作导致了以下假设：生命体征，12-铅ECG和血清肌钙蛋白测量的异常可以识别出严重PE的心肺应力。 对于该项目，将筛选的筛查工具定义为休克指数（脉搏/收缩压）的组合<0.8，脉搏血氧蛋白读数> 91％，丹尼尔ECG得分<8点<8点，肌钙蛋白i <0.4 ng/mh，该项目的较低率（对筛查仪器的假设都没有penteriagriage and Imbard），这是对右心脏的造成的，这是对且具有较低的变形（rv）。用标准治疗的PE处理的死亡或心肺疾病：抗凝治疗。 该项目的第一个具体目的是使用经胸膜超声心动图作为标准标准的RV菌株测试所提出的筛选工具的诊断准确性。 第二个目标将比较筛选仪器的诊断准确性与超声心动图，以预测PE的不良结果。 由于筛选仪器可能无法预测复发或未解决的PE损害RV损害，因此第二个假设是非恶性血栓形成条件会增加PE的不良结果风险。 因此，：第三个目标将测试是否因不良预后而复杂的PE患者是否更有可能具有抗磷脂抗体，或因子V Leiden G1691A，凝血酶蛋白G20210a，甲基环甲基甲基二酸酯还原酸还原酶C677T的C677T突变，或低红细胞的浓度与甲基甲基甲基甲基甲基甲基甲基甲基甲基甲基抗体：据相比： 结果。 不良的临床结果将包括死亡或缺氧的大脑侮辱：在诊断后六个月后，确定诊断，复发性PE或心pe虫的30天之内。 纽约心脏协会功能II或更糟糕的心脏肺部残疾将定义，或更糟糕的是，具有持久的RV菌株的重复经胸超声心动图，步行六分钟小于330米。 这项研究将确定大多数医院的标准是否广泛且立即可用于风险划分PE的严重程度，并阐明非恶性血栓形成对PE预后的作用。

项目成果

Findings From 12-lead Electrocardiography That Predict Circulatory Shock From Pulmonary Embolism: Systematic Review and Meta-analysis.

• DOI: 10.1111/acem.12769
• 发表时间: 2015-10
• 期刊: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
• 作者: Shopp JD;Stewart LK;Emmett TW;Kline JA
• 通讯作者: Kline JA

Patient Protection and Affordable Care Act of 2010: summary, analysis, and opportunities for advocacy for the academic emergency physician.

2010 年患者保护和平价医疗法案：摘要、分析以及为学术急诊医师宣传的机会。

• DOI: 10.1111/j.1553-2712.2010.00802.x
• 发表时间: 2010
• 期刊: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
• 作者: Kline,JeffreyA;Walthall,JenniferDH
• 通讯作者: Walthall,JenniferDH

Frequency of thrombophilia-related genetic variations in patients with idiopathic pulmonary embolism in an urban emergency department.

城市急诊科特发性肺栓塞患者血栓形成倾向相关基因变异的频率。

• DOI: 10.1373/clinchem.2005.061861
• 发表时间: 2006
• 期刊: Clinical chemistry
• 影响因子: 9.3
• 作者: Kruse,Lori;Mitchell,AliceM;CamargoJr,CarlosA;Hernandez,Jackeline;Kline,JeffreyA
• 通讯作者: Kline,JeffreyA