Department of Angiology and Blood Coagulation Marino Golinelli, University Hospital S. Orsola-Malpighi, Via Albertoni, 15, Bologna, Italy.
Intern Emerg Med. 2011 Dec;6(6):521-8. doi: 10.1007/s11739-011-0577-8. Epub 2011 Apr 3.
The rate of resolution of a first episode of pulmonary embolism (PE) is uncertain. A baseline test indicating any residual PE is pivotal in aiding a more accurate diagnosis of recurrent PE. This study aimed to assess the rate and risk factors of residual PE with either multidetector computed tomography imaging (MDCT) or lung perfusion scan (LPS) using a cross-sectional study in which consecutive patients were enrolled with a first objectively documented episode of symptomatic PE, and who were considered for possible treatment withdrawal after at least 3 months of anticoagulation. A first cohort of patients (n = 80) underwent MDCT, while the subsequent cohort (n = 93) underwent LPS. The two cohorts had similar characteristics, and 98.3% of patients had non high-risk index PE. MDCT detected residual PE in 15% of subjects (12/80, 95% CI 8-25%) after a mean of 9 months of anticoagulation. No clinical characteristics were significantly associated with residual PE at MDCT. LPS detected residual PE in 28% (26/93, 95% CI 19-38%) of patients after a period of a mean of 9 months of anticoagulation with a significant association with increasing age and known pulmonary disease. Resolution of PE was high after a first episode of non high-risk PE treated with heparin followed by at least 3 months of anticoagulation. Age and coexistent pulmonary disease influence the presence of residual PE detected by LPS, but not by MDCT. Further studies are warranted in which the presence of residual embolism is detected by repetition of the same test that had been initially carried out.
首次肺栓塞 (PE) 发作的缓解率尚不确定。基线检查表明任何残留的 PE 对更准确地诊断复发性 PE 至关重要。本研究旨在通过一项横断面研究评估多排螺旋 CT 成像 (MDCT) 或肺灌注扫描 (LPS) 检查显示残留 PE 的发生率和危险因素，该研究纳入了连续的首次经客观记录的有症状 PE 发作且考虑在抗凝治疗至少 3 个月后可能停止治疗的患者。第一组患者 (n = 80) 接受 MDCT 检查，随后一组患者 (n = 93) 接受 LPS 检查。两组患者的特征相似，98.3%的患者患有非高危指数 PE。抗凝治疗 9 个月后，MDCT 检测到 15%的患者 (12/80，95%CI 8-25%) 存在残留 PE。MDCT 检查未发现与残留 PE 相关的临床特征。在抗凝治疗 9 个月后，LPS 检测到 28%的患者 (26/93，95%CI 19-38%) 存在残留 PE，与年龄增加和已知肺部疾病显著相关。肝素治疗非高危指数 PE 发作后，经至少 3 个月抗凝治疗，PE 可完全缓解。年龄和并存肺部疾病影响 LPS 检测到的残留 PE 的存在，但不影响 MDCT 检查。有必要进行进一步的研究，用最初进行的相同检查重复检测残留栓塞的存在。
