pulmonary thromboembolism in patients after covid-19: predictive indicators for correct diagnosis

Background: infection caused by sars-cov-2 can lead to significant procoagulant events, sometimes involving life-threatening pulmonary thromboembolism (pe). additional conditions complicating the diagnosis are the presence of risk factors for pe in almost all patients with covid-19 and the overlap of clinical presentation between pe and covid-19. objectives:we conducted a single-center study at the heart and brain hospital, pleven, from december 2020 to february 2021. it included 27 consecutively hospitalized patients with recent pneumonia caused by covid-19 and clinical presentations corresponding to pe. methods: the cohort was divided into two groups with and without a definitive diagnosis of pe, proven by ct pulmoangiography. the aim was to find the indicators predicting the presence of pe in patients with acute or post-acute covid-19 conditions. results: our results showed that some ecg criteria, including s-wave over 1.5mmin leads i and avl (p = 0.007), q-wave in leads iii and avf (p = 0.020), and d-dimer as a quantitative variable (p = 0.025), were independent predictors of pe. the rv/lv diameter ratios ≥1.0 and right ventricular dysfunction showed a sensitivity (se) of 62.5%, specificity (sp) of 100%, positive predictive value (ppv) of 100%, and negative predictive value (npv) of 86.4% to verify the pe diagnosis. besides, the d-dimer cutoff value of 1,032 ng/ml had an optimal se of 87.5%, sp of 57.9%, ppv of 46.7%, and npv of 91.7% for pe diagnosis (p = 0.021). conclusions: against the background of acute and post-acute covid-19 conditions, ecg and echocg criteria remain the pe predictors. we suggest that a higher d-dimer cutoff value be applied in covid-19 and post-covid-19 patients to confirm/dismiss pe diagnosis.