Section of Clinical Physiology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Am J Emerg Med. 2013 Mar;31(3):482-6. doi: 10.1016/j.ajem.2012.09.016. Epub 2012 Nov 12.
Right ventricular (RV) involvement in pulmonary embolism (PE) is an ominous sign. The aim of this study was to investigate the extent to which the d-dimer level or simplified PE severity index (sPESI) indicates RV dysfunction in patients with preserved systemic arterial pressure.
Right ventricular function was studied in 34 consecutive patients with acute nonmassive PE by echocardiography including Doppler tissue imaging within 24 hours after arrival to the hospital. d-Dimer and sPESI were assessed upon arrival.
d-Dimer correlated with RV pressure (Rs, 0.60; P < .001) and pulmonary vascular resistance (PVR; Rs, 0.68; P < .0001) and tended to be related to myocardial performance index (MPI; Rs, 0.31; P = .067). Compared to a level less than 3.0 mg/L, patients with d-dimer 3.0 mg/L or higher had lower systolic tricuspid annular velocity (11.3 ± 2.7 vs 13.5 ± 2.7 cm/s; P < .05), a prolonged MPI (0.8 ± 0.3 vs 0.5 ± 0.2; P < .01), increased RV pressure (58 ± 13 vs 37 ± 12 mm Hg; P < .001), and increased PVR (3.3 ± 1.1 vs 1.8 ± 0.4 Woods units; P < .001). Patients in the high-risk sPESI group had higher filling pressure than those in the low risk sPESI group.
In the acute stage of PE, a d-dimer level 3 mg/L or higher may identify nonmassive PE patients with RV dysfunction and thereby help to determine their risk profile. We found no additional value for sPESI in this context.
右心室（RV）受累是肺栓塞（PE）的一个危险信号。本研究旨在探讨 d-二聚体水平或简化的 PE 严重指数（sPESI）在血压正常的急性非大面积 PE 患者中对 RV 功能障碍的指示程度。
通过超声心动图（包括入院后 24 小时内的多普勒组织成像）研究了 34 例连续急性非大面积 PE 患者的 RV 功能。入院时评估 d-二聚体和 sPESI。
d-二聚体与 RV 压力（Rs，0.60；P <.001）和肺血管阻力（PVR；Rs，0.68；P <.0001）相关，且与心肌做功指数（MPI；Rs，0.31；P =.067）呈正相关。与 d-二聚体水平 < 3.0 mg/L 的患者相比，d-二聚体水平为 3.0 mg/L 或更高的患者收缩期三尖瓣环速度较低（11.3 ± 2.7 与 13.5 ± 2.7 cm/s；P <.05），MPI 延长（0.8 ± 0.3 与 0.5 ± 0.2；P <.01），RV 压力升高（58 ± 13 与 37 ± 12 mm Hg；P <.001），PVR 增加（3.3 ± 1.1 与 1.8 ± 0.4 Woods 单位；P <.001）。高危 sPESI 组患者的充盈压高于低危 sPESI 组。
在 PE 的急性阶段，d-二聚体水平≥3 mg/L 可能会识别出 RV 功能障碍的非大面积 PE 患者，从而有助于确定其风险特征。在这种情况下，sPESI 没有额外的价值。
