Grifoni Stefano, Vanni Simone, Magazzini Simone, Olivotto Iacopo, Conti Alberto, Zanobetti Maurizio, Polidori Gianluca, Pieralli Filippo, Peiman Nazerian, Becattini Cecilia, Agnelli Giancarlo
Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Arch Intern Med. 2006 Oct 23;166(19):2151-6. doi: 10.1001/archinte.166.19.2151.
In patients with acute pulmonary embolism, right ventricular dysfunction (RVD) on hospital admission is a predictor of adverse short-term clinical outcome. The aim of this study was to evaluate the prognostic value of RVD persistence at hospital discharge with regard to the likelihood of recurrent venous thromboembolism (VTE).
Echocardiography was used to assess RVD on admission and before hospital discharge in 301 consecutive patients with the first episode of acute pulmonary embolism occurring from January 1998 through July 2004. Right ventricular dysfunction was diagnosed in the presence of 1 or more of the following: right ventricular dilation (without hypertrophy), paradoxical septal systolic motion, and Doppler evidence of pulmonary hypertension. Patients were followed up at 2, 6, and 12 months and yearly thereafter. The primary end point was symptomatic, recurrent fatal or nonfatal VTE.
Patients were categorized as those (1) without RVD (155 patients [51.5%]), (2) with RVD regression (RVD on admission but not at discharge; 87 patients [28.9%]), and (3) with persistent RVD (RVD on admission and at discharge; 59 patients [19.6%]). After a mean +/- SD of 3.1 +/- 2.7 years, patients with RVD persistence showed an increased risk of recurrent VTE (14 patients, 9.2% patient-years) compared with those without RVD (15 patients, 3.1% patient-years) or RVD regression (3 patients, 1.1% patient-years) (P = .001). Six of 8 deaths related to pulmonary embolism occurred in patients with RVD persistence. At multivariate analysis, adjusted by anticoagulant treatment duration, RVD persistence was an independent predictor of recurrent VTE (hazard ratio, 3.79; P<.001).
Persistent RVD at hospital discharge after an acute pulmonary embolism is associated with recurrent VTE.
在急性肺栓塞患者中，入院时右心室功能障碍（RVD）是短期临床不良结局的预测指标。本研究的目的是评估出院时RVD持续存在对复发性静脉血栓栓塞（VTE）可能性的预后价值。
采用超声心动图对1998年1月至2004年7月连续收治的301例首次发生急性肺栓塞的患者在入院时和出院前进行RVD评估。当出现以下1种或更多情况时诊断为右心室功能障碍：右心室扩张（无肥厚）、室间隔矛盾运动以及肺动脉高压的多普勒证据。对患者进行2个月、6个月和12个月的随访，此后每年随访一次。主要终点是有症状的、复发性致命或非致命性VTE。
患者被分为三组：（1）无RVD组（155例患者[51.5%]），（2）RVD消退组（入院时有RVD但出院时无；87例患者[28.9%]），以及（3）RVD持续存在组（入院时和出院时均有RVD；59例患者[19.6%]）。平均±标准差为3.1±2.7年后，RVD持续存在的患者复发性VTE风险增加（14例患者，9.2%患者年），高于无RVD患者（15例患者，3.1%患者年）或RVD消退患者（3例患者，1.1%患者年）（P = 0.001）。8例与肺栓塞相关的死亡中有6例发生在RVD持续存在的患者中。在多变量分析中，经抗凝治疗持续时间校正后，RVD持续存在是复发性VTE的独立预测因素（风险比，3.79；P<0.001）。
急性肺栓塞后出院时RVD持续存在与复发性VTE相关。
