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Malcolm M. Bersohn, MD, PhD; Shelley Shapiro, MD, PhD
Author and Funding Information

From the VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at the University of California, Los Angeles.

Correspondence to: Malcolm M. Bersohn, MD, PhD, VA Greater Los Angeles Healthcare System, Cardiology (111E), 11301 Wilshire Blvd, Los Angeles, CA 90073; e-mail: mbersohn@ucla.edu


Funding/Support: Funding and support for the REVEAL Registry were provided by Cotherix Inc and its affiliate Actelion Pharmaceuticals US Inc.

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Bersohn has received grant/research support from Actelion Pharmaceuticals US Inc; Bayer AG; Biotronik SE & CoKG; Medtronic, Inc; Sorin Group; and St. Jude Medical, Inc. Dr Shapiro has received research grants from Actelion Pharmaceuticals US Inc; Bayer AG; GeNO LLC; Gilead Sciences Inc; Ikaria, Inc; Medtronic, Inc; and United Therapeutics Corp and has served as a consultant for United Therapeutics Corp and as a speaker for Actelion Pharmaceuticals US Inc, United Therapeutics Corp, and Gilead Sciences Inc.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(2):414-415. doi:10.1378/chest.13-2401
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Published online
To the Editor:

We were previously unaware of research using the shock index (SI) in patients with pulmonary embolism,1 which Drs Nobre and Thomas have brought to our attention in their comments regarding our article.2 We appreciate their sharing unpublished data about prognostic indicators in acute pulmonary embolism. Because SI = heart rate (HR)/systolic BP (SBP), it is the inverse of the SBP/HR that we found to be a strong predictor of survival and hospitalization in a cohort of 2,830 patients with pulmonary arterial hypertension in the Registry to Evaluate Early and Long-term PAH [Pulmonary Arterial Hypertension] Disease Management (REVEAL Registry).2 Therefore, the SI would have exactly the same prognostic value as SBP/HR except that high values would indicate a worse prognosis and low values would indicate a better prognosis. It is gratifying to learn that in patients with acute pulmonary embolism the SBP/HR also correlates with the severity of disease, as suggested by the decision to treat with thrombolytic therapy, and with the response to therapy.

Acknowledgments

Role of sponsors: The sponsor provided financial support for the REVEAL Registry but had no role in this correspondence.

Other contributions: This work was performed at 54 participating sites across the United States.

Kucher N, Luder CM, Dörnhöfer T, Windecker S, Meier B, Hess OM. Novel management strategy for patients with suspected pulmonary embolism. Eur Heart J. 2003;24(4):366-376. [CrossRef] [PubMed]
 
Bersohn MM, Turner MP, Traiger GL, Frost AE, Shapiro S. Systemic BP and heart rate as prognostic indicators in pulmonary arterial hypertension. Chest. 2013;144(3):959-965. [CrossRef] [PubMed]
 

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References

Kucher N, Luder CM, Dörnhöfer T, Windecker S, Meier B, Hess OM. Novel management strategy for patients with suspected pulmonary embolism. Eur Heart J. 2003;24(4):366-376. [CrossRef] [PubMed]
 
Bersohn MM, Turner MP, Traiger GL, Frost AE, Shapiro S. Systemic BP and heart rate as prognostic indicators in pulmonary arterial hypertension. Chest. 2013;144(3):959-965. [CrossRef] [PubMed]
 
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