Engelke C, Rummeny E, Marten K
Radiologie, Klinikum rechts der Isar der Technischen Universität München.
Rofo. 2006 Oct;178(10):999-1006. doi: 10.1055/s-2006-926962.
Evaluation of the prognostic value of morphological cardiac parameters in patients with suspected and incidental acute pulmonary embolism (PE) using multidetector-row chest CT (MSCT).
2335 consecutive MSCT scans were evaluated for the presence of PE. The arterial enhancement and analysability of pulmonary arteries and the heart were assessed as parameters of the scan quality. The diastolic right and left ventricular short axes (RV (D), LV (D)) and the interventricular septal deviation (ISD) were measured in all PE-positive patients and the echocardiography reports were reviewed. The clinical data assessment included cardio-respiratory and other co-morbidities, systemic anticoagulant therapy (ACT), and the 30-day outcome. Predictors of acute cor pulmonale and the short-term outcome were calculated by univariate and multivariate logistic regressions including odds ratios (OR) and ROC analyses using positive (PPV) and negative predictive values (NPV).
90 patients with acute PE were included (36 with clinically suspected PE, 54 with incidental PE). 26 patients had cardio-respiratory co-morbidities. Four patients underwent systemic thrombolysis, 43 underwent anticoagulation in therapeutic doses, 19 underwent anticoagulation in prophylactic doses, and 24 patients did not undergo ACT. 15 of 41 patients had echocardiographic evidence of acute cor pulmonale. 8 patients died within 30 days. The RV (D) was the best independent predictor of acute cor pulmonale (p = 0,002, OR = 9.16, PPV = 0.68, NPV = 1 at 4.49 cm cut off) and short-term outcome (p = 0,0005, OR = 2.82, PPV = 0.23, NPV = 0.98 at 4.75 cm cut off). The RV (D)/LV (D) ratio had a PPV of 0.85 for cor pulmonale.
The RV (D) and RV (D)/LV (D) ratio were suitable for identifying patients with acute cor pulmonale and for benign short-term prognosis. Further studies should prospectively address the combined use of CT-morphological and clinical parameters for the prediction of patient outcome.
使用多排螺旋胸部CT（MSCT）评估疑似和偶然发现的急性肺栓塞（PE）患者心脏形态学参数的预后价值。
对2335例连续的MSCT扫描进行PE存在情况的评估。评估肺动脉和心脏的动脉强化及可分析性作为扫描质量参数。在所有PE阳性患者中测量舒张期右心室和左心室短轴（RV（D），LV（D））以及室间隔偏移（ISD），并回顾超声心动图报告。临床数据评估包括心肺及其他合并症、全身抗凝治疗（ACT）以及30天结局。通过单因素和多因素逻辑回归计算急性肺心病和短期结局的预测因素，包括比值比（OR）以及使用阳性预测值（PPV）和阴性预测值（NPV）的ROC分析。
纳入90例急性PE患者（36例临床疑似PE，54例偶然发现PE）。26例患者有心肺合并症。4例患者接受全身溶栓治疗，43例接受治疗剂量抗凝，19例接受预防剂量抗凝，24例患者未接受ACT。41例患者中有 15例有急性肺心病的超声心动图证据。8例患者在30天内死亡。RV（D）是急性肺心病的最佳独立预测因素（p = 0.002，OR = 9.16，PPV = 0.68，在截断值为4.49 cm时NPV = 1）和短期结局的最佳独立预测因素（p = 0.0005，OR = 2.82，PPV = 0.23，在截断值为4.75 cm时NPV = 0.98）。RV（D）/LV（D）比值对肺心病的PPV为0.85。
RV（D）和RV（D）/LV（D）比值适用于识别急性肺心病患者和预测短期良性预后。进一步的研究应前瞻性地探讨CT形态学和临床参数联合用于预测患者结局。
