Publications by authors named "Parth Rali"

Background: Acute pulmonary embolism (PE) is a leading cause of morbidity and mortality. Pharmacomechanical lysis (PML) with the Bashir endovascular catheter has been shown to reduce the right ventricular/left ventricular (RV/LV) ratio in patients with intermediate-risk (IR) PE. Nevertheless, the original protocol required a 5-hour postprocedural infusion of recombinant tissue plasminogen activator (r-tPA) and intensive care unit monitoring.

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Pulmonary embolism (PE) is a leading cause of mortality in lung transplant recipients, with early cases associated with particularly poor outcomes. Identified risk factors include elevated BMI, renal dysfunction, ABO mismatch, donor malignancy, and specific immunosuppressive agents. Tailored risk assessments and targeted interventions are essential to mitigating PE-related mortality.

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Current risk assessment of pulmonary embolism (PE) stratifies patients based on hemodynamic stability, clinical parameters of severity, right ventricular dysfunction and cardiac injury but fails to integrate a wide variety of comorbid conditions. The Charlson Comorbidity Index (CCI) predicts mortality based on patients' diseases and provides a system to quantify disease burden. The National Inpatient Sample (NIS) database (2016-2018) was used to identify patients with PE and calculate CCI score groups of 0, 1-2, 3-5, and ≥6 and stratify them by outcome.

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Article Synopsis
  • A study called PEERLESS compared two catheter methods, large-bore mechanical thrombectomy (LBMT) and catheter-directed thrombolysis (CDT), for treating intermediate-risk pulmonary embolism (PE) in 550 patients, focusing on various health outcomes.
  • The results showed that LBMT led to fewer complications and less need for intensive care compared to CDT, including lower rates of clinical deterioration and ICU admissions.
  • Although LBMT had better short-term outcomes, there were no significant differences in mortality or major bleeding between the two treatment methods after 30 days.
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Residual Pulmonary Vascular Obstruction (RPVO) is an area of increasing focus in patients with acute pulmonary embolism (PE) due to its association with long-term morbidity and mortality. The predictive factors and the effect catheter-directed therapies (CDT) have on RPVO are still under investigation. This is a single-center retrospective review between April 2017 and July 2021.

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Background: To evaluate the occurrence of malnutrition in pulmonary embolism (PE)-related hospitalisations and assess the impact of malnutrition on the outcomes of patients with PE.

Methods: A retrospective observational study using data extracted from the Nationwide Inpatient Sample from 2016 to 2018. Hospitalisations with a principal diagnosis of PE were obtained using International Classification of Diseases, Tenth Revision codes and divided into groups based on a secondary diagnosis of malnutrition.

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Article Synopsis
  • The study investigates the impact of pulmonary arterial hypertension (PAH)-specific therapy on mortality in patients with pulmonary hypertension (PH) linked to lung disease.
  • In a cohort of 783 patients, those with severe PH (defined as pulmonary vascular resistance greater than 5 Wood units) who received PAH therapy showed a significant increase in survival probability compared to those who did not receive the treatment.
  • The findings suggest that PAH-specific therapy may reduce mortality specifically in patients with chronic lung disease and severe PH, indicating a potential benefit similar to that seen in traditional PAH cases.
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Objective: Major progress in reperfusion strategies has substantially improved the short-term outcomes of patients with pulmonary embolism (PE), however, up to 50% of patients report persistent dyspnea after acute PE.

Methods: A retrospective study of the PE response team registry and included patients with repeat imaging at 3 to 12 months. The primary outcome was to determine the incidence of residual pulmonary vascular obstruction following acute PE.

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Article Synopsis
  • * Results showed a significant decrease in occlusions: segmental occlusions dropped from 40.5% to 11.7% and proximal occlusions from 28.7% to 11.0% within 48 hours post-treatment.
  • * The improvement in segmental artery occlusions was linked to a reduction in right ventricular size, indicating a potential benefit of PM-CDT in lowering mortality risk associated with PE.
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Pulmonary embolism (PE) is the third leading cause of cardiovascular death in the United States. Black Americans have higher incidence, greater clot severity, and worse outcomes than White Americans. This disparity is not fully understood, especially in the context of the advent of PE response teams (PERT), which aim to standardize PE-related care.

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Background: The Composite Pulmonary Embolism Shock (CPES) score has been developed to identify normotensive patients with acute pulmonary embolism (PE) and a low cardiac index (referred to as normotensive shock). We aimed to externally assess the validity of this model for predicting a complicated course among hemodynamically stable patients with acute PE.

Methods: Using prospectively collected data from the PROgnosTic valuE of Computed Tomography scan (PROTECT) study, we calculated the CPES score for each patient and the proportion of patients with a score > 3.

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High-risk acute pulmonary embolism (PE), defined as acute PE associated with hemodynamic instability, remains a significant contributor to cardiovascular morbidity and mortality in the United States and worldwide. Historically, anticoagulant therapy in addition to systemic thrombolysis has been the mainstays of medical therapy for the majority of patients with high-risk PE. In efforts to reduce the morbidity and mortality, a wide array of interventional and surgical therapies has been developed and employed in the management of these patients.

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Introduction: Right ventricular dysfunction (RVD) is a key component in the process of risk stratification in patients with acute pulmonary embolism (PE). Echocardiography remains the gold standard for RVD assessment, however, measures of RVD may be seen on CTPA imaging, including increased pulmonary artery diameter (PAD). The aim of our study was to evaluate the association between PAD and echocardiographic parameters of RVD in patients with acute PE.

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Rosai-Dorfman disease (RDD) is a rare form of non-Langerhans histiocytosis. It is often idiopathic in etiology, but has been associated with viral, autoimmune, and malignant disease. Adequate diagnosis of RDD requires a combination of clinical symptoms, radiography, and histology.

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Background: Interhospital transfer (IHT) of patients with acute life-threatening pulmonary embolism (PE) is necessary to facilitate specialized care and access to advanced therapies. Our goal was to understand what barriers and facilitators may exist during this transfer process from the perspective of both receiving and referring physicians.

Methods: This qualitative descriptive study explored physician experience taking care of patients with life threatening PE.

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Atrial myxomas, though the most common primary cardiac neoplasm, remain a rare disease occurring in about 0.03% of the population. While clinically benign, they are considered functionally malignant as they can cause life-threatening embolic events.

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Objective: Pulmonary infarction is a common clinical and radiographic finding in acute pulmonary embolism (PE), yet the clinical relevance and prognostic significance of pulmonary infarction remain unclear. The study aims to investigate the clinical features, radiographic characteristics, impact of reperfusion therapy and outcomes of patients with pulmonary infarction.

Design, Setting And Participants: A retrospective cohort study of 496 adult patients (≥18 years of age) diagnosed with PE who were evaluated by the PE response team at a tertiary academic referral centre in the USA.

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Article Synopsis
  • Pulmonary embolism (PE) can show a wide range of symptoms, from none at all to severe hemodynamic collapse, despite similar appearances of clots in imaging tests.
  • The authors aimed to find a link between the age of the blood clots and the patients' clinical symptoms by examining the clots under a microscope.
  • They studied 13 thrombectomy samples from PE patients to determine the age of the thrombus based on its microscopic features and how it related to the patients' clinical outcomes.
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Background: Catheter-directed thrombolysis (CDT) has been associated with rapid recovery of right ventricular (RV) function. The Bashir catheter was developed for enhanced thrombolysis in large vessels such as the pulmonary arteries (PAs) with lower doses of tissue plasminogen activator (tPA).

Objectives: The aim of this study was to evaluate the efficacy and safety of tPA infused using a pharmacomechanical (PM) CDT device called the Bashir endovascular catheter in patients with intermediate-risk acute pulmonary embolism (PE).

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Background: The impact of pulmonary embolism response teams (PERTs) on treatment choice and outcomes of patients with acute pulmonary embolism (PE) is still uncertain.

Objective: To determine the effect of PERTs in the management and outcomes of patients with PE.

Methods: PubMed, Embase, Web of Science, CINAHL, WorldWideScience and MedRxiv were searched for original articles reporting PERT patient outcomes from 2009.

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