George Elizabeth, Kumamaru Kanako K, Ghosh Nina, Gonzalez Quesada Carlos, Wake Nicole, Bedayat Arash, Dunne Ruth M, Saboo Sachin S, Khandelwal Ashish, Hunsaker Andetta R, Rybicki Frank J, Gerhard-Herman Marie
*Applied Imaging Science Laboratory, Department of Radiology †Department of Medicine, Cardiovascular Division ‡Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston §Department of Radiology, University of Massachusetts Medical School, Worcester, MA.
J Thorac Imaging. 2014 Jan;29(1):W7-12. doi: 10.1097/RTI.0000000000000048.
The aim of the study was to compare the prognostic value of right ventricular (RV) dysfunction detected on computed tomography pulmonary angiography (CTPA) and transthoracic echocardiography (TTE) in patients with acute pulmonary embolism (PE).
From all consecutive CTPAs performed between August 2003 and May 2010 that were positive for acute PE (n=1744), those with TTE performed within 48 hours of CTPA (n=785) were selected as the study cohort. Multivariate logistic regression analysis was performed to assess the association of CTPA RV/left ventricular (LV) diameter ratio and TTE RV strain with PE-related 30-day mortality, including other associated factors as covariates. The predictive ability (area under the curve) was compared between the model including the CT RV/LV diameter ratio and that including TTE RV strain. Test characteristics of the 2 modalities were calculated.
Both CT RV/LV diameter ratio and TTE RV strain were independently associated with PE-related 30-day mortality (adjusted odds ratio=1.14, P=0.023 for 0.1 increment of the CT RV/LV diameter ratio; and odds ratio=2.13, P=0.041 for TTE RV strain). History of congestive heart failure and malignancy were independent predictors of PE-related mortality, while there was significantly lower mortality associated with anticoagulation use. The model including TTE RV strain and that including CT RV/LV had similar predictive ability (area under the curve=0.80 vs. 0.81, P=0.50). The sensitivity, specificity, and positive and negative predictive values of TTE RV strain and CT RV/LV diameter ratio at a cutoff of ≥1.0 were similar for PE-related 30-day mortality.
Both RV strain on TTE and an increased CT RV/LV diameter ratio are predictors of PE-related 30-day mortality with similar prognostic significance.
本研究旨在比较计算机断层扫描肺动脉造影（CTPA）和经胸超声心动图（TTE）检测到的右心室（RV）功能障碍对急性肺栓塞（PE）患者的预后价值。
在2003年8月至2010年5月期间连续进行的所有急性PE阳性的CTPA（n = 1744）中，选择在CTPA后48小时内进行TTE检查的患者（n = 785）作为研究队列。进行多变量逻辑回归分析，以评估CTPA右心室/左心室（LV）直径比和TTE右心室应变与PE相关的30天死亡率的关联，包括其他相关因素作为协变量。比较包含CT右心室/左心室直径比的模型和包含TTE右心室应变的模型的预测能力（曲线下面积）。计算这两种检查方式的检测特征。
CT右心室/左心室直径比和TTE右心室应变均与PE相关的30天死亡率独立相关（校正比值比 = 1.14，CT右心室/左心室直径比每增加0.1，P = 0.023；TTE右心室应变的比值比 = 2.13，P = 0.041）。充血性心力衰竭病史和恶性肿瘤是PE相关死亡率的独立预测因素，而使用抗凝治疗与死亡率显著降低相关。包含TTE右心室应变的模型和包含CT右心室/左心室直径比的模型具有相似的预测能力（曲线下面积 = 0.80对0.81，P = 0.50）。对于PE相关的30天死亡率，TTE右心室应变和CT右心室/左心室直径比在截断值≥1.0时的敏感性、特异性以及阳性和阴性预测值相似。
TTE检测到的右心室应变增加和CT右心室/左心室直径比升高均为PE相关30天死亡率的预测因素，具有相似的预后意义。
