Khemasuwan Danai, Yingchoncharoen Teerapat, Tunsupon Pichapong, Kusunose Kenya, Moghekar Ajit, Klein Allan, Tonelli Adriano R
Interventional Pulmonary, Henry Ford Hospital, Detroit, Michigan.
Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Am Soc Echocardiogr. 2015 Mar;28(3):355-62. doi: 10.1016/j.echo.2014.11.012. Epub 2015 Jan 2.
There is limited information on the utility of certain echocardiographic measurements, such as right ventricular (RV) strain analysis, in predicting mortality in patients with acute pulmonary embolism (PE).
A total of 211 patients with acute PE admitted to a medical intensive care unit (ICU) were retrospectively identified. Echocardiographic variables were prospectively measured in this cohort. The focus was on ICU, hospital, and long-term mortality.
The mean age was 61 ± 15 years. Median Acute Physiology and Chronic Health Evaluation IV and simplified Pulmonary Embolism Severity Index scores were 60 (interquartile range, 40-71) and 2 (interquartile range, 1-2), respectively. Thirty-eight patients (18%) died during the sentinel hospitalization (13% died in the ICU). A total of 61 patients (28.9%) died during a median follow-up period of 15 months (interquartile range, 5-26 months). The echocardiographic variables associated with long-term mortality (from PE diagnosis) were ratio of RV to left ventricular end-diastolic diameter (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.2-4.8), tricuspid annular plane systolic excursion (HR, 0.53; 95% CI, 0.31-0.92), and RV-right atrial gradient (HR, 1.02; 95% CI, 1.01-1.4). ICU mortality was associated with ratio of RV to LV end-diastolic diameter (HR, 4.4; 95% CI, 1.3-15), RV systolic pressure (HR, 1.03; 95% CI, 1.01-1.05), tricuspid annular plane systolic excursion (HR, 0.4; 95% CI, 0.18-0.9), and inferior vena cava collapsibility < 50% (HR, 4.3; 95% CI, 1.7-11). These variables remain significantly associated with mortality after adjusting by Acute Physiology and Chronic Health Evaluation IV score, Pulmonary Embolism Severity Index score, or the use of thrombolytic agents. RV strain parameters were not correlated with hospital or long-term mortality.
Four simple parameters that measure different aspects of the right ventricle (ratio of RV to left ventricular end-diastolic diameter, RV systolic pressure, tricuspid annular plane systolic excursion, and inferior vena cava collapsibility) were independently associated with mortality in patients presenting with acute PE who were admitted to the ICU.
关于某些超声心动图测量指标，如右心室（RV）应变分析，在预测急性肺栓塞（PE）患者死亡率方面的效用，相关信息有限。
回顾性纳入了211例入住医学重症监护病房（ICU）的急性PE患者。对该队列患者前瞻性地测量了超声心动图变量。重点关注ICU死亡率、医院死亡率和长期死亡率。
平均年龄为61±15岁。急性生理与慢性健康状况评分系统IV（APACHE IV）和简化肺栓塞严重程度指数（sPESI）的中位数分别为60（四分位间距，40 - 71）和2（四分位间距，1 - 2）。38例患者（18%）在首次住院期间死亡（13%在ICU死亡）。在中位随访期15个月（四分位间距，5 - 26个月）内，共有61例患者（28.9%）死亡。与长期死亡率（自PE诊断起）相关的超声心动图变量包括右心室与左心室舒张末期内径比值（风险比[HR]，2.4；95%置信区间[CI]，1.2 - 4.8）、三尖瓣环平面收缩期位移（HR，0.53；95% CI，0.31 - 0.92）以及右心室 - 右心房压差（HR，1.02；95% CI，1.01 - 1.4）。ICU死亡率与右心室与左心室舒张末期内径比值（HR，4.4；95% CI，1.3 - 15）、右心室收缩压（HR，1.03；95% CI，1.01 - 1.05）、三尖瓣环平面收缩期位移（HR，0.4；95% CI，0.18 - 0.9）以及下腔静脉塌陷度<50%（HR，4.3；95% CI，1.7 - 11）相关。在校正APACHE IV评分、sPESI评分或使用溶栓药物后，这些变量仍与死亡率显著相关。右心室应变参数与医院死亡率或长期死亡率无关。
四个简单参数（右心室与左心室舒张末期内径比值、右心室收缩压、三尖瓣环平面收缩期位移和下腔静脉塌陷度），它们分别测量右心室不同方面，独立与入住ICU的急性PE患者死亡率相关。
