Respiratory Department, Ramón y Cajal Hospital, IRYCIS, , Madrid, Spain.
Thorax. 2014 Feb;69(2):109-15. doi: 10.1136/thoraxjnl-2012-202900. Epub 2013 Mar 22.
In patients with acute pulmonary embolism (PE), rapid and accurate risk assessment is paramount in selecting the appropriate treatment strategy. The prognostic value of right ventricular dysfunction (RVD) assessed by multidetector CT (MDCT) in normotensive patients with PE has lacked adequate validation.
The study defined MDCT-assessed RVD as a ratio of the RV to the left ventricle short axis diameter greater than 0.9. Outcomes assessed through 30 days after the diagnosis of PE included all-cause mortality and 'complicated course', which consisted of death from any cause, haemodynamic collapse or recurrent PE.
MDCT detected RVD in 533 (63%) of the 848 enrolled patients. Those with RVD on MDCT more frequently had echocardiographic RVD (31%) than those without RVD on MDCT (9.2%) (p<0.001). Patients with RVD on MDCT had significantly higher brain natriuretic peptide (269±447 vs 180±457 pg/ml, p<0.001) and troponin (0.10±0.43 vs 0.03±0.24 ng/ml, p=0.001) levels in comparison with those without RVD on MDCT. During follow-up, death occurred in 25 patients with and in 13 patients without RVD on MDCT (4.7% vs 4.3%; p=0.93). Those with and those without RVD on MDCT had a similar frequency of complicated course (3.9% vs 2.3%; p=0.30).
The PROgnosTic valuE of CT study showed a relationship between RVD assessed by MDCT and other markers of cardiac dysfunction around the time of PE diagnosis, but did not demonstrate an association between MDCT-RVD and prognosis.
在急性肺栓塞（PE）患者中，快速准确的风险评估对于选择合适的治疗策略至关重要。多排 CT（MDCT）评估的正常血压 PE 患者右心室功能障碍（RVD）的预后价值尚未得到充分验证。
该研究将 MDCT 评估的 RVD 定义为 RV 与左心室短轴直径的比值大于 0.9。通过 PE 诊断后 30 天评估的结局包括全因死亡率和“复杂病程”，后者包括任何原因导致的死亡、血流动力学崩溃或复发性 PE。
848 名纳入患者中，MDCT 检测到 533 例（63%）存在 RVD。MDCT 上存在 RVD 的患者比 MDCT 上无 RVD 的患者更频繁地出现超声心动图 RVD（31% vs. 9.2%，p<0.001）。与 MDCT 上无 RVD 的患者相比，MDCT 上存在 RVD 的患者的脑钠肽（269±447 vs. 180±457 pg/ml，p<0.001）和肌钙蛋白（0.10±0.43 vs. 0.03±0.24 ng/ml，p=0.001）水平显著更高。随访期间，MDCT 上存在 RVD 的患者中有 25 例死亡，MDCT 上无 RVD 的患者中有 13 例死亡（4.7% vs. 4.3%，p=0.93）。MDCT 上存在 RVD 的患者与 MDCT 上无 RVD 的患者发生复杂病程的频率相似（3.9% vs. 2.3%，p=0.30）。
CT 研究的预后价值显示 MDCT 评估的 RVD 与 PE 诊断时其他心脏功能障碍标志物之间存在关系，但 MDCT-RVD 与预后之间没有关联。
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