Pulmonary embolism lastest guidelines
pulmonary embolism guidelines 2024 2025 ESC AHA latest recommendations
"pulmonary embolism"[MeSH Terms] AND "guideline"[pt]
https://www.ecccp.org/infographic-aha-acc-2026-guidelines-ac…
PMID: 41712677
pulmonary embolism risk stratification management algorithm CT angiography

A medical infographic and diagnostic algorithm in Portuguese for risk stratification of acute pulmonary embolism (APE). At the center is a diagnostic image: a transverse/axial CT pulmonary angiogram (CTPA) showing the mediastinum and major hilar vessels, including the pulmonary artery and heart chambers. The algorithm branches into three risk categories: 'Baixo Risco' (Low Risk), defined by a PESI score ≤ II and absence of right ventricular (RV) dilation; 'Alto Risco' (High Risk), characterized by circulatory shock (SBP < 90 mmHg) or cardiorespiratory arrest; and 'Risco intermediário' (Intermediate Risk). The intermediate section details an association of biomarkers across three scoring systems: the BOVA score (incorporating SBP, troponin, RV dysfunction, and heart rate), the TELOS score (lactate, troponin, and RV dysfunction), and the SHIELD score (shock index, lactate, hypoxemia, and RV dysfunction). Arrows indicate the clinical flow based on positive or negative scores, integrating clinical vitals, imaging findings of RV strain, and laboratory markers for triage and management.

This composite educational graphic combines diagnostic imaging and a clinical decision-making algorithm for the risk stratification of acute pulmonary embolism (PE). At the center is an axial view of a Contrast-Enhanced Computed Tomography (CT) scan of the chest, specifically a CT pulmonary angiogram (CTPA). The image displays the thoracic cage, lungs, mediastinum, and cardiac structures, notably demonstrating filling defects in the pulmonary arteries consistent with PE. The surrounding flowchart categorizes PE severity into three tiers: Low-Risk, Intermediate-Risk, and High-Risk. Low-Risk is defined by a Pulmonary Embolism Severity Index (PESI) score ≤ II and absence of Right Ventricular (RV) dilatation. High-Risk is identified by hemodynamic instability (circulatory shock, SBP < 90 mmHg, or cardiorespiratory arrest). The Intermediate-Risk section utilizes integrated biomarkers and scoring systems, including the BOVA score (focusing on SBP, troponin, RV dysfunction, and heart rate), the TELOS score (lactate, troponin, and RV dysfunction), and the SHIELD score (shock index, lactate, hypoxemia, and RV dysfunction). This educational visual illustrates how imaging findings of RV strain and clinical scores guide patient prognosis and triage.

This infographic presents misclassified examples from a multimodal classifier designed for Pulmonary Embolism (PE) risk stratification, comparing Electronic Health Record (EHR) features and 3D CT Pulmonary Angiography (CTPA) imaging. (a) Displays a false negative case featuring a bar chart of EHR feature importance (e.g., Pulmonary heart disease, Patients Complaint, CRP) and corresponding 3D Grad-CAM heatmaps overlaying the left ventricle and pulmonary artery. (b) Shows two false positive examples with their respective feature importance rankings (including Phosphorus, WBC, and Urea) and Grad-CAM visualizations. The heatmaps in these cases highlight the pulmonary trunk, aorta, right ventricle chamber, and areas indicating potential PE clots. This visual provides an educational comparison of how deep learning models utilize diverse data modalities to assess acute PE severity, illustrating anatomical regions of high diagnostic importance such as the heart chambers and major thoracic vessels. It serves as a study of model interpretability and the clinical relevance of multimodal diagnostic fusion.
| Category | Description | Key Features |
|---|---|---|
| A | At risk | No acute PE yet; risk factors present |
| B | Beginning/Mild | Hemodynamically stable, no RV strain, low severity score |
| C | Intermediate (3 subcategories) | C1: elevated severity score, normal RV + biomarkers; C2: RV dysfunction OR abnormal biomarkers; C3: both RV dysfunction AND elevated biomarkers |
| D | Deteriorating | Normotensive shock or rapid clinical deterioration; D1-D2 subcategories |
| E | Extremis/High-risk | Overt hemodynamic collapse, cardiac arrest; E1-E2 subcategories |
| Category | Preferred Advanced Therapy |
|---|---|
| A-C1 | Anticoagulation only (Class 3: do NOT use MT) |
| C2-C3 | Anticoagulation +/- consider catheter-directed therapy if deteriorating |
| D1-D2 | Catheter-directed thrombolysis (CDT) or mechanical thrombectomy (MT) - Class 2b for MT |
| E1 | Systemic thrombolysis OR MT - Class 2a for MT; surgical embolectomy if available |
| E2 (arrest) | Systemic thrombolysis + ECMO; surgical embolectomy |
| Feature | ESC 2019 | AHA/ACC 2026 |
|---|---|---|
| Risk classification | Low/Intermediate-low/Intermediate-high/High | 5-tier A-E system |
| BNP in risk stratification | Supplementary | Formally incorporated |
| PERTs | Mentioned | Class 1 recommendation |
| MT for intermediate-risk | Not addressed | Class 2b for D1-D2 |
| Normotensive shock | Not explicitly defined | Explicitly categorized (D) |
| Outpatient management | Limited guidance | Explicit ED discharge criteria |

Note: The 2026 guideline has a published erratum (PMID: 42441758); verify the final published version for any corrected recommendations.