心电图同步 CT 扫描测量急性肺栓塞患者左右心室功能：预测短期预后的价值。
Measurement of right and left ventricular function by ECG-synchronized CT scanning in patients with acute pulmonary embolism: usefulness for predicting short-term outcome.
机构信息
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
Section of Vascular Medicine, Department of General Internal Medicine-Endocrinology, Leiden University Medical Center, Leiden, The Netherlands.
出版信息
Chest. 2011 Oct;140(4):1008-1015. doi: 10.1378/chest.10-3174. Epub 2011 Apr 7.
BACKGROUND
Right ventricular (RV) function is predictive of outcome in patients with acute pulmonary embolism (PE). We assessed the possible incremental value of ventricular function with ECG-synchronized cardiac CT scanning over pulmonary CT scan angiography (CTA) for predicting short-term outcome in patients with suspected acute PE.
METHODS
The local ethics committee approved the study, and informed consent was obtained. In addition to standard CTA, 430 consecutive patients (193 men, 237 women; age, 55 ± 17 years) with suspected acute PE underwent ECG-synchronized CT scanning to assess ventricular function. RV/left ventricular (LV) function ratio and pulmonary obstruction index were obtained from non-ECG-synchronized CTA. Ventricular function was used to predict adverse events (< 6 weeks). Receiver operating characteristic analysis was performed to determine differences between ECG-synchronized CT scan and CTA in predicting outcome.
RESULTS
In 113 patients with PE, RV and LV ejection fraction (EF) and RV/LV diameter and volume ratios were associated with adverse outcome (P < .05), whereas vascular obstruction index was not. RVEF had the largest area under the receiver operating characteristic curve (0.75; 95% CI, 0.62-0.88) for predicting adverse outcome but had no significant incremental value over the RV/LV function ratio (0.72; 95% CI, 0.57-0.86; P = .25). All parameters revealed high negative predictive values (94%-98%) but low positive predictive values (13%-18%). For disease-specific outcome, areas under the curve were 0.80 (95% CI, 0.69-0.91) for RVEF vs 0.68 (95% CI, 0.48-0.88) for axial RV/LV ratio; the difference was not significant (P = .07). RVEF and RV/LV ratio proved better predictors for outcome than pulmonary obstruction index (both P < .001).
CONCLUSIONS
RVEF was the best predictor for clinical outcome in patients with acute PE. However, incremental value of RVEF over axial RV/LV ratio was not found.
背景
右心室（RV）功能是急性肺栓塞（PE）患者预后的预测因素。我们评估了心电图同步心脏 CT 扫描对肺动脉 CT 血管造影（CTA）在预测疑似急性 PE 患者短期预后方面的可能附加价值。
方法
当地伦理委员会批准了该研究，并获得了知情同意。除了标准 CTA 外，430 例连续疑似急性 PE 患者（193 例男性，237 例女性；年龄 55 ± 17 岁）接受了心电图同步 CT 扫描以评估心室功能。RV/左心室（LV）功能比和肺阻塞指数是从非心电图同步 CTA 获得的。心室功能用于预测不良事件（<6 周）。进行了受试者工作特征分析，以确定心电图同步 CT 扫描与 CTA 在预测结局方面的差异。
结果
在 113 例 PE 患者中，RV 和 LV 射血分数（EF）以及 RV/LV 直径和容积比与不良结局相关（P<0.05），而血管阻塞指数则没有。RVEF 对预测不良结局的受试者工作特征曲线下面积最大（0.75；95%CI，0.62-0.88），但与 RV/LV 功能比（0.72；95%CI，0.57-0.86；P=0.25）相比无显著附加价值。所有参数均显示出高阴性预测值（94%-98%），但低阳性预测值（13%-18%）。对于特定疾病的结局，RVEF 的曲线下面积为 0.80（95%CI，0.69-0.91），而轴向 RV/LV 比为 0.68（95%CI，0.48-0.88）；差异无统计学意义（P=0.07）。RVEF 和 RV/LV 比均优于肺阻塞指数（均 P<0.001），是预后的更好预测因子。
结论
RVEF 是急性 PE 患者临床结局的最佳预测因子。然而，并未发现 RVEF 比轴向 RV/LV 比具有附加价值。
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