Fijałkowska Anna, Szczerba Ewa, Szewczyk Grzegorz, Budaj-Fidecka Anna, Burakowski Janusz, Sobkowicz Bożena, Nowowiejska-Wiewióra Alicja, Opolski Grzegorz, Torbicki Adam, Kurzyna Marcin
Department of Cardiology, Institute of Mother and Child, Warsaw, Poland.
First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Arch Med Sci. 2018 Jun;14(4):838-845. doi: 10.5114/aoms.2017.70896. Epub 2017 Oct 20.
Pulmonary embolism (PE) is a leading cause of mortality in pregnancy and a great diagnostic challenge. Deviations from the recommended diagnostic pathway in suspected PE contribute to greater mortality in the general population. The deviations from the guidelines of the European Society of Cardiology (ESC) for diagnosis of PE were analyzed, with particular emphasis on pregnant women with suspected PE.
ZATPOL is a prospective national registry including data of all patients with suspected PE admitted to 86 Polish cardiology departments between January 2007 and September 2008. We analyzed diagnostic pathways used in all 2015 patients (mean age: 67 ±15 years, 60% women) with suspected PE. Detailed analysis included diagnostic pathways used in 12 pregnant patients and 85 non-pregnant women in childbearing age.
Pregnancy was the strongest predictor of deviations from the recommended diagnostic pathway in the whole study group (HR = 4.0, 95% CI: 1.28-12.5, = 0.02). Pregnant patients did not differ significantly from non-pregnant women in most risk factors and symptoms of PE, and diagnostic tests used in this condition. Deviations from the recommended diagnostic pathway were found in 7 (58%) and 36 (42%) pregnant and non-pregnant women, respectively ( = 0.297), and the preliminary diagnosis of PE was eventually confirmed in 42% and 67% of the patients, respectively ( = 0.086).
Despite the lack of significant differences in PE symptomatology in pregnant and non-pregnant women, pregnancy seems to be the strongest predictor of deviations from the diagnostic pathway recommended in PE by the ESC. Further studies are required to evaluate the adherence to current guidelines in pregnant women.
肺栓塞（PE）是妊娠期间导致死亡的主要原因，也是一项重大的诊断挑战。疑似PE患者偏离推荐的诊断途径会导致普通人群死亡率更高。本研究分析了欧洲心脏病学会（ESC）诊断PE指南的偏离情况，特别关注疑似PE的孕妇。
ZATPOL是一项前瞻性全国登记研究，纳入了2007年1月至2008年9月期间波兰86个心脏病科收治的所有疑似PE患者的数据。我们分析了所有2015例疑似PE患者（平均年龄：67±15岁，60%为女性）所采用的诊断途径。详细分析包括12例孕妇和85例育龄非孕妇所采用的诊断途径。
在整个研究组中，妊娠是偏离推荐诊断途径的最强预测因素（HR = 4.0，95%CI：1.28 - 12.5，P = 0.02）。在大多数PE危险因素、症状以及针对这种情况所使用的诊断检查方面，孕妇与非孕妇没有显著差异。分别在7例（58%）孕妇和36例（42%）非孕妇中发现了偏离推荐诊断途径的情况（P = 0.297），最终分别在42%和67%的患者中确诊为PE（P = 0.086）。
尽管孕妇和非孕妇在PE症状学方面没有显著差异，但妊娠似乎是ESC推荐的PE诊断途径偏离的最强预测因素。需要进一步研究来评估孕妇对当前指南的遵循情况。
