Lack of functional information explains the poor performance of ‘clot load scores’ at predicting outcome in acute pulmonary embolism

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dc.contributor.author Clark, Alys en
dc.contributor.author Milne, D en
dc.contributor.author Wilsher, M en
dc.contributor.author Burrowes, Kelly en
dc.contributor.author Bajaj, M en
dc.contributor.author Tawhai, Merryn en
dc.date.accessioned 2016-11-23T21:23:57Z en
dc.date.issued 2014-01-01 en
dc.identifier.citation Respiratory Physiology and Neurobiology, 2014, 190, pp. 1-13 en
dc.identifier.issn 1569-9048 en
dc.identifier.uri http://hdl.handle.net/2292/31130 en
dc.description.abstract Clot load scores have previously been developed with the goal of improving prognosis in acute pulmonary embolism (PE). These scores provide a simple estimate of pulmonary vascular bed obstruction, however they have not been adopted clinically as they have poor correlation with mortality and right ventricular (RV) dysfunction. This study performed a quantitative analysis of blood flow and gas exchange in 12 patient-specific models of PE, to understand the limitations of current clot load scores and how their prognostic value could be improved. Prediction of hypoxemia in the models when using estimated baseline (non-occluded) minute ventilation and cardiac output correlated closely with clinical metrics for RV dysfunction, whereas the clot load score had only a weak correlation. The model predicts that large central clots have a greater impact on function than smaller distributed clots with the same total clot load, and that the partial occlusion of a vessel only has a significant impact on pulmonary function when the vessel is close to completely occluded. The effect of clot distribution on the redistribution of blood from its normal pattern - and hence the magnitude of the potential effect on gas exchange - is represented in the model but is not included in current clot load scores. Improved scoring systems need to account for the expected normal distribution of blood in the lung, and the impact of clot on redistributing the blood flow. en
dc.description.uri http://www.journals.elsevier.com/respiratory-physiology-and-neurobiology en
dc.publisher Elsevier en
dc.relation.ispartofseries Respiratory Physiology and Neurobiology en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. Details obtained from http://www.sherpa.ac.uk/romeo/issn/1569-9048/ en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/4.0/ en
dc.subject Computational model en
dc.subject Gas exchange en
dc.subject Perfusion en
dc.subject Pulmonary embolism en
dc.subject Pulmonary pathology en
dc.subject Acute Disease en
dc.subject Adult en
dc.subject Aged en
dc.subject Blood Coagulation en
dc.subject Computer Simulation en
dc.subject Female en
dc.subject Humans en
dc.subject Lung en
dc.subject Male en
dc.subject Middle Aged en
dc.subject Models, Cardiovascular en
dc.subject Pulmonary Embolism en
dc.subject Severity of Illness Index en
dc.subject Tomography Scanners, X-Ray Computed en
dc.subject Ventricular Dysfunction, Right en
dc.title Lack of functional information explains the poor performance of ‘clot load scores’ at predicting outcome in acute pulmonary embolism en
dc.type Journal Article en
dc.identifier.doi 10.1016/j.resp.2013.09.005 en
pubs.begin-page 1 en
pubs.volume 190 en
dc.description.version AM - Accepted Manuscript en
dc.rights.holder Copyright: Elsevier en
dc.identifier.pmid 24080246 en
pubs.author-url http://www.sciencedirect.com/science/article/pii/S156990481300311X en
pubs.end-page 13 en
pubs.publication-status Published en
dc.rights.accessrights http://purl.org/eprint/accessRights/OpenAccess en
pubs.subtype Article en
pubs.elements-id 407397 en
pubs.org-id Bioengineering Institute en
pubs.org-id ABI Associates en
dc.identifier.eissn 1878-1519 en
dc.identifier.pii S1569-9048(13)00311-X en
pubs.record-created-at-source-date 2016-11-24 en
pubs.dimensions-id 24080246 en


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http://creativecommons.org/licenses/by-nc-nd/4.0/ Except where otherwise noted, this item's license is described as http://creativecommons.org/licenses/by-nc-nd/4.0/

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