Pulmonary embolism risk stratification: where are we heading?

Prevention of exacerbations of chronic obstructive pulmonary disease with tiotropium, a once-daily inhaled anticholinergic bronchodilator: a randomized trial. Stabilization of the bioactivity of tumor necrosis factor by its soluble receptors. The relationship between chronic hypoxemia and activation of the tumor necrosis factor-alpha system in patients with chronic obstructive pulmonary disease. Soluble tumor necrosis factor receptors are elevated in relation to severity of congestive heart failure. Distinct sputum cytokine profiles in cystic fibrosis and other chronic inflammatory airway disease. We read with great interest the paper by SANCHEZ et al. [1], in which the authors suggested that biomarkers and echocardiography findings would provide additional prognostic information to traditional risk models, such as the pulmonary embolism severity index (PESI), in normotensive acute pulmonary embolism (PE) patients. Patients were assigned to low-(PESI I–II), intermediate-(PESI III–IV) and high-risk classes (PESI V) and further stratified according to right ventricle dysfunction markers (right ventricle/left ventricle ratio, and troponin and brain natriuretic peptide (BNP) levels). The authors reported that low-risk PESI patients without any right ventricle dysfunction markers had a significantly lower risk for adverse events than low-risk patients with abnormal right ventricle/left ventricle ratio, troponin and/or BNP levels. However, the same results were not found for the remaining PESI classes (intermediate and high risk).