University J Fourrier, Grenoble, France.
Eur J Radiol. 2011 Sep;79(3):452-8. doi: 10.1016/j.ejrad.2010.03.013. Epub 2010 Apr 18.
The goal of this study was to retrospectively evaluate CT cardiovascular parameters and pulmonary artery clot load score as predictors of 3-month mortality in patients with clinically non-severe pulmonary embolism (PE). We included 226 CT positive for PE in hemodynamically stable patients (112 women; mean age 67.1 years ± 16.9). CT were independently reviewed by two observers. Results were compared with occurrence of death within 3 months using Cox regression. Twenty-four (10.6%) patients died, for whom 9 were considered to be due to PE. Interobserver agreement was moderate for the shape of interventricular septum (κ = 0.41), and for the ratio between the diameters of right and left ventricle (RV/LV) (κ = 0.76). Observers found no association between interventricular septum shape and death. A RV/LV diameter ratio >1 was predictive of death (OR, 3.83; p < 0.01) only when we also took into account the value of the embolic burden (< 40%). In a multivariate model, CT cardiovascular parameters were not associated with death. Concomitant lower limb DVT and comorbid conditions were important predictors of death. In clinically non-severe PE, a RV/LV diameter ratio >1 is predictive of death when the embolic burden is low (< 40%).
本研究旨在回顾性评估 CT 心血管参数和肺动脉血栓负荷评分对临床非重症肺栓塞（PE）患者 3 个月死亡率的预测价值。共纳入 226 例血流动力学稳定的 CT 阳性 PE 患者（女性 112 例，平均年龄 67.1 ± 16.9 岁）。由两名观察者独立进行 CT 评估。采用 Cox 回归比较 CT 结果与 3 个月内死亡的发生情况。24 例（10.6%）患者死亡，其中 9 例被认为与 PE 相关。观察者发现室间隔形状（κ=0.41）和右心室/左心室直径比（RV/LV）（κ=0.76）的观察者间一致性为中度。室间隔形状与死亡之间无关联。仅当同时考虑栓塞负荷值（<40%）时，RV/LV 直径比>1 是死亡的预测因子（OR，3.83；p<0.01）。在多变量模型中，CT 心血管参数与死亡无关。下肢深静脉血栓形成和并存疾病是死亡的重要预测因子。在临床非重症 PE 中，当栓塞负荷较低（<40%）时，RV/LV 直径比>1 是死亡的预测因子。
