CT 肺动脉造影显示右心室扩张可独立预测肺栓塞患者的死亡率。

Right ventricular dilation on CT pulmonary angiogram independently predicts mortality in pulmonary embolism.

机构信息

Department of Respiratory Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK.

出版信息

Respir Med. 2010 Jul;104(7):1057-62. doi: 10.1016/j.rmed.2010.02.004. Epub 2010 Mar 3.

DOI:10.1016/j.rmed.2010.02.004

PMID:20202807

Abstract

BACKGROUND

The aim of this study was to determine the prognostic significance of right ventricular dilation on CT pulmonary angiogram in acute pulmonary embolism and to distinguish if this feature predicts mortality independently of the Pulmonary Embolism Severity Index, an established admission severity score.

METHODS

A retrospective study of patients admitted with pulmonary embolism confirmed by CT pulmonary angiogram to three teaching hospitals in East Scotland between January 2005 and July 2007. Two radiologists judged presence of right ventricular dilation on CT pulmonary angiogram independently. The outcome of interest was 30 day mortality. Multivariable logistic regression was used to compare this outcome in patients with right ventricular dilation compared to those without right ventricular dilation, adjusting for Pulmonary Embolism Severity Index score.

RESULTS

There were 585 patients included and 30.4% had right ventricular dilation on CT pulmonary angiogram. Patients with right ventricular dilation had increased 30 day mortality rates compared to patients without right ventricular dilation (12.4% vs. 5.4%; p=0.006). Survival analysis showed that a significantly greater proportion of deaths in the right ventricular dilation group occurred within the first 48h after admission compared to the group without right ventricular dilation (45.5% deaths vs. 9.1%; p=0.016). On multivariable analysis, adjusting for Pulmonary Embolism Severity Index score, right ventricular dilation was independently associated with increased 30 day mortality (OR 2.98; 95% CI 1.54-5.75; p=0.001).

CONCLUSION

Right ventricular dilation on CT pulmonary angiogram is an independent predictor of 30 day mortality in acute pulmonary embolism.

摘要

背景

本研究旨在确定 CT 肺动脉造影中右心室扩张对急性肺栓塞的预后意义，并确定该特征是否可独立于已确立的入院严重程度评分——肺栓塞严重程度指数来预测死亡率。

方法

回顾性研究了 2005 年 1 月至 2007 年 7 月期间在苏格兰东部的三家教学医院因 CT 肺动脉造影确诊的肺栓塞患者。两位放射科医生独立判断 CT 肺动脉造影中右心室扩张的存在。主要结局是 30 天死亡率。多变量逻辑回归用于比较右心室扩张患者与无右心室扩张患者的这种结局，调整肺栓塞严重程度指数评分。

结果

共纳入 585 例患者，其中 30.4%的患者 CT 肺动脉造影显示右心室扩张。与无右心室扩张的患者相比，右心室扩张的患者 30 天死亡率更高（12.4%比 5.4%；p=0.006）。生存分析显示，与无右心室扩张的患者相比，右心室扩张组的死亡比例在入院后前 48 小时内显著更高（45.5%的死亡人数与 9.1%；p=0.016）。多变量分析调整肺栓塞严重程度指数评分后，右心室扩张与 30 天死亡率增加独立相关（OR 2.98；95% CI 1.54-5.75；p=0.001）。