Viorel Manea

Background: The increasing use of routine oncological imaging has led to more frequent detection of incidental pulmonary embolism (PE), potentially modifying the contemporary clinical presentation of cancer-associated pulmonary embolism (CAPE). Methods: We performed a retrospective cohort study including 381 consecutive patients hospitalized with acute PE, of whom 58 had active cancer and 323 had no active malignancy. The primary endpoint was a Severe Hemodynamic Presentation Composite Endpoint (SHPCE), defined as shock, systolic blood pressure < 90 mmHg, and/or high-risk PE according to European Society of Cardiology criteria. Clinical characteristics, severity markers, management strategies, and in-hospital outcomes were compared between patients with CAPE and non-cancer PE (NCPE). Multivariable logistic regression analyses were performed to evaluate factors associated with SHPCE and incidental PE. Results: The patients with CAPE had higher PESI (129.8 ± 29.3 vs. 110.1 ± 32.3; p < 0.001) and sPESI scores (3.03 ± 0.56 vs. 2.68 ± 0.81; p < 0.001), and lower hemoglobin levels (11.7 ± 1.9 vs. 13.2 ± 1.8 g/dL; p < 0.001). Incidental PE was more frequent in CAPE than NCPE cases (13.8% vs. 1.9%; OR 8.45, 95% CI 2.81–25.39; p < 0.001). Despite their higher baseline risk scores, patients with CAPE and NCPE showed similar rates of SHPCE (12.1% vs. 17.6%; p = 0.295), ICU admission (10.3% vs. 11.5%; p = 1.000), and in-hospital mortality (10.3% vs. 11.1%; p = 0.858). In multivariable analyses, right ventricular dysfunction (RVD) showed the strongest association with SHPCE (adjusted OR 10.21, 95% CI 5.34–19.52; p < 0.001), whereas active cancer was not associated with severe presentation. Conclusions: Active cancer was associated with higher clinical risk scores and a greater prevalence of incidental PE but not with increased hemodynamic severity or adverse in-hospital outcomes. Acute PE severity appeared to be more closely related to right ventricular involvement than to cancer status, supporting a severity-based rather than cancer-based approach to risk assessment.

Background: The increasing use of routine oncological imaging has led to more frequent detection of incidental pulmonary embolism (PE), potentially modifying the contemporary clinical presentation of cancer-associated pulmonary embolism (CAPE). Methods: We performed a retrospective cohort study including 381 consecutive patients hospitalized with acute PE, of whom 58 had active cancer and 323 had no active malignancy. The primary endpoint was a Severe Hemodynamic Presentation Composite Endpoint (SHPCE), defined as shock, systolic blood pressure < 90 mmHg, and/or high-risk PE according to European Society of Cardiology criteria. Clinical characteristics, se-verity markers, management strategies, and in-hospital outcomes were compared between patients with CAPE and non-cancer PE (NCPE). Multivariable logistic regression analyses were performed to evaluate factors as-sociated with SHPCE and incidental PE. Results: The CAPE patients had higher PESI (129.8 ± 29.3 vs. 110.1 ± 32.3; p< 0.001) and sPESI scores (3.03 ± 0.56 vs. 2.68 ± 0.81; p< 0.001), and lower hemoglobin levels (11.7 ± 1.9 vs. 13.2 ± 1.8 g/dL; p< 0.001). Incidental PE was more frequent in CAPE than NCPE cases (13.8% vs. 1.9%; OR 8.45, 95% CI 2.81–25.39; p< 0.001). Despite their higher baseline risk scores, patients with CAPE and NCPE showed similar rates of SHPCE (12.1% vs. 17.6%; p=0.295), ICU admission (10.3% vs. 11.5%; p=1.000), and in-hospital mortality (10.3% vs. 11.1%; p=0.858). In multivariable analyses, right ventricular dysfunction showed the strongest association with SHPCE (adjusted OR 10.21, 95% CI 5.34–19.52; p< 0.001), whereas active cancer was not associated with severe presentation. Conclusions: Active cancer was associated with higher clinical risk scores and a greater prevalence of incidental PE but not with increased hemodynamic severity or adverse in-hospital outcomes. Acute PE severity appeared to be more closely related to right ventricular involvement than to cancer status, supporting a severity-based rather than cancer-based approach to risk assessment.

Background: Ambulatory blood pressure monitoring (ABPM) in patients with diabetes mellitus (DM) and hypertension (HTN) show the dipping patterns, identify masked uncontrolled hypertension (MUCH), and demonstrate the effectiveness of the blood pressure (BP) treatment. MUCH is associated with a two-fold higher risk of adverse events. Prevalence in patients with DM is between 13.3 and 66.4%. Our study aims to investigate the prevalence of MUCH and the BP patterns in a population of apparently well-controlled hypertensive patients with type 2 DM (T2DM). A second aspect was the assessment of the effectiveness of antihypertensive treatment. Methods: One hundred and sixty-three consecutively treated hypertensive patients with T2DM and an office BP between 130–139 and 80–89 mmHg performed a 24 h ABPM. The circadian BP variation, the presence of MUCH, and the correlations with the treatment were assessed. Results: There were 75 dippers (46.02%), 77 non-dippers (47.23%), 4 reverse dippers (2.45%), and 7 extreme dippers (4.30%). Eighty-one patients (77 non-dippers + 4 reverse dippers; 49.7%) had isolated nocturnal MUCH according to the mean night ABPM criteria. Dippers and extreme dippers (75 dippers + 7 extreme dippers; 51.3%) did not have any MUCH criteria. The patients took, on an average, 3 antihypertensive drugs with no difference between those with controlled HTN and the isolated nocturnal MUCH group. Significant factors associated with isolated nocturnal MUCH and a non-dipping BP pattern included age > 65 years (OR = 1.9), DM duration > 10 years (OR = 1.4), HTN duration > 6.5 years (OR = 1.2), obesity (OR = 1.6), and cardiovascular comorbidities (OR = 1.4). Conclusions: The current study shows that half of the treated hypertensive patients with T2DM and office clinical normotension are non-dippers or reverse dippers. They experience isolated nocturnal MUCH due to their elevated nocturnal BP values, which comply with the actual definition of masked nocturnal hypertension. Bedtime chronotherapy in those patients could be linked to better effectiveness of antihypertensive treatment during the night with the important goal of reducing cardiovascular and cerebrovascular adverse events. ABPM should be performed in hypertensive patients with DM for better risk stratification and more effective control of HTN.