Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Fred Hutchinson Cancer Center, Seattle, WA, USA.
J Thromb Thrombolysis. 2018 Feb;45(2):257-263. doi: 10.1007/s11239-018-1608-3.
Obesity is a well-established risk factor for pulmonary embolism (PE). However, treatment of PE in obese patients is challenging because of limited outcomes data, especially with advanced therapies such as catheter-based fibrinolysis. We assessed the efficacy and safety of ultrasound-facilitated, catheter-directed fibrinolysis in obese patients with submassive and massive PE enrolled in the SEATTLE II Trial. Eligible patients had a right ventricular-to-left ventricular (RV/LV) diameter ratio ≥ 0.9 on chest computed tomography (CT). The primary efficacy outcome was the change in chest CT-measured RV/LV diameter ratio at 48 h after procedure initiation. The primary safety outcome was GUSTO major bleeding within 72 h. One-hundred and four patients were obese, as defined by a BMI ≥ 30 kg/m, and 44 were non-obese. Mean RV/LV ratio was greater in obese patients at baseline compared with non-obese patients (1.60 vs. 1.43, p = 0.02). Reduction in RV/LV diameter ratio at 48 h was greater in obese patients compared with non-obese patients (absolute reduction: - 0.47 vs. - 0.30, p = 0.01; relative reduction: - 26 vs. - 18%, p = 0.03). Major bleeding occurred in 12 (12%) of obese patients and in 3 (7%) in non-obese patients (p = 0.55). In conclusion, ultrasound-facilitated, catheter-directed fibrinolysis shows promise in obese patients for whom advanced therapy for acute PE is warranted.
肥胖是肺栓塞（PE）的一个明确的危险因素。然而，由于有限的研究结果数据，尤其是对于先进的治疗方法，如基于导管的溶栓，肥胖患者的 PE 治疗具有挑战性。我们评估了超声辅助、导管定向溶栓治疗在西雅图 II 试验中入组的亚大块和大块 PE 肥胖患者中的疗效和安全性。合格患者的胸部 CT 显示右心室与左心室（RV/LV）直径比≥0.9。主要疗效终点是治疗开始后 48 小时胸部 CT 测量的 RV/LV 直径比的变化。主要安全性终点是 72 小时内 GUSTO 大出血。104 名患者肥胖，BMI≥30kg/m2，44 名患者非肥胖。与非肥胖患者相比，肥胖患者的基线 RV/LV 比值更高（1.60 比 1.43，p=0.02）。与非肥胖患者相比，肥胖患者在 48 小时时 RV/LV 直径比的降低更大（绝对降低：-0.47 比-0.30，p=0.01；相对降低：-26%比-18%，p=0.03）。12 名（12%）肥胖患者和 3 名（7%）非肥胖患者发生大出血（p=0.55）。总之，超声辅助、导管定向溶栓治疗为需要急性 PE 高级治疗的肥胖患者提供了希望。
