Yıldırım Birdal, Biteker Funda Sungur, Başaran Özcan, Alataş Ömer Doğan, Acar Ethem, Sözen Hamdi, Doğan Volkan, Beydilli Halil, Çaylak Selmin Dirgen
Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Emergency Medicine.
Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology.
Am J Emerg Med. 2015 Nov;33(11):1672-6. doi: 10.1016/j.ajem.2015.06.036. Epub 2015 Jun 19.
The role of echocardiography in adult patients with community-acquired pneumonia (CAP) has not been tested in a clinical trial. The aim of the study was to assess the cardiac changes secondary to CAP by echocardiography and to find out the correlation between echocardiographic findings and the severity of CAP.
A total of 111 unselected consecutive adult patients hospitalized with CAP were enrolled. The control group consisted of 100 consecutive sex- and age-matched patients. The severity of CAP was evaluated with the pneumonia severity index and the CURB-65 (confusion, urea, respiratory rate, arterial blood pressure and age) score. Blood samples were taken and echocardiography was performed within the first 48 hours.
White blood count, N-terminal pro-brain natriuretic peptide, and red blood cell distribution width were significantly higher in the CAP group compared with the control group. The 2 groups did not differ in terms of left and right ventricle ejection fraction, left atrial diameter, pulmonary artery systolic pressure, and left ventricular end-diastolic and end-systolic diameter. However, tricuspid annular plane systolic excursion (21.1 ± 4.3 vs 22.3 ± 4.1 mm; P = .04), aortic distensibility (2.5 ± 0.9 vs 3.5 ± 0.9 cm(2):dyne:10, P < .001), and aortic strain (5.8% ± 2% vs 6.5% ± 1.9%, P = .009) were significantly reduced in CAP group than in controls. The plasma concentration of N-terminal pro-brain natriuretic peptide correlated with aortic strain, aortic distensibility, tricuspid annular plane systolic excursion, pneumonia severity index score, and CURB-65 score.
Tricuspid annular plane systolic excursion and elastic properties of aorta may play a role in the diagnosis and clinical assessment of CAP severity, which could potentially guide the development of new prognostic models.
超声心动图在社区获得性肺炎（CAP）成年患者中的作用尚未在临床试验中得到验证。本研究的目的是通过超声心动图评估CAP继发的心脏变化，并找出超声心动图检查结果与CAP严重程度之间的相关性。
共纳入111例未经选择的连续住院的CAP成年患者。对照组由100例年龄和性别匹配的连续患者组成。采用肺炎严重指数和CURB-65（意识障碍、尿素、呼吸频率、动脉血压和年龄）评分评估CAP的严重程度。在最初48小时内采集血样并进行超声心动图检查。
与对照组相比，CAP组的白细胞计数、N末端脑钠肽前体和红细胞分布宽度显著更高。两组在左、右心室射血分数、左心房直径、肺动脉收缩压以及左心室舒张末期和收缩末期直径方面无差异。然而，CAP组的三尖瓣环平面收缩期位移（21.1±4.3 vs 22.3±4.1 mm；P = 0.04）、主动脉扩张性（2.5±0.9 vs 3.5±0.9 cm²:dyne:10，P < 0.001）和主动脉应变（5.8%±2% vs 6.5%±1.9%，P = 0.009）均显著低于对照组。N末端脑钠肽前体的血浆浓度与主动脉应变、主动脉扩张性、三尖瓣环平面收缩期位移、肺炎严重指数评分和CURB-65评分相关。
三尖瓣环平面收缩期位移和主动脉弹性特性可能在CAP严重程度的诊断和临床评估中起作用，这可能潜在地指导新的预后模型的开发。
