Advanced Radiology Services, PC, Spectrum Health Hospitals, 100 Michigan St NE, Grand Rapids, MI 49503.
Cardiology, Spectrum Health Hospitals, 100 Michigan St NE, Grand Rapids, MI 49503.
J Vasc Interv Radiol. 2019 May;30(5):734-741. doi: 10.1016/j.jvir.2018.08.027. Epub 2019 Mar 8.
To evaluate the clinical effectiveness of ultrasound-assisted thrombolysis (USAT) in resolution of right ventricular dysfunction (RVD), preservation of cardiopulmonary function, and quality of life (QoL) in patients with acute submassive pulmonary embolism (PE).
A single-center prospective study of patients presenting with acute PE and signs of RVD, as determined by right ventricle-to-left ventricle diameter ratio (RV:LV) > 0.9 on computed tomographic angiography of the thorax, was performed. Patients underwent USAT with recombinant tissue plasminogen activator. Primary endpoints measured were RV:LV by echocardiogram at baseline presentation and at 72 hours and 90 days after treatment. Secondary endpoints were QoL scores assessed by SF-36 Health Surveys at baseline and at 90 days, cardiopulmonary exercise test (CPET) parameters at 90 days, and procedural outcomes, including response of pulmonary artery pressure (PAP) and procedural complications.
Twenty-five patients were treated between June 17, 2013, and September 15, 2014, with mean reduction of RV:LV by echocardiogram from 1.38 ± 0.28 at presentation to 0.92 ± 0.14 (P < .0001) at 72 hours and 0.84 ± 0.25 (P < .0001) at 90 days. SF-36 Health Survey scores demonstrated no long-term self-perceived adverse physical or mental effects as a result of PE. CPET parameters, including VO2, weight-adjusted VO2, VE/VCO2, and VD/VT demonstrated no pulmonary vascular impairment at 90 days. PAP significantly improved after USAT, with mean initial systolic pressure of 50.46 ± 13.98 mmHg reduced to 39.64 ± 8.66 mmHg (P = .0001). There were no deaths, recurrent venous thromboembolism, hemodynamic decompensation, or hemorrhage.
USAT resulted in significant reduction of RV:LV at 72 hours, which was preserved at 90 days. QoL and objective measures of cardiopulmonary function are preserved at 90 days in this population. Further studies with long-term follow-up are needed to determine the potential value of USAT for the prevention of post-PE syndrome in patients with submassive PE.
评估超声辅助溶栓（USAT）在急性亚大块肺栓塞（PE）患者右心室功能障碍（RVD）缓解、心肺功能保护和生活质量（QoL）方面的临床疗效。
对因右心室与左心室直径比（RV：LV）> 0.9 而在胸部 CT 血管造影中显示有 RVD 征象的急性 PE 患者进行了一项单中心前瞻性研究。患者接受重组组织型纤溶酶原激活剂的 USAT。主要终点为基线、治疗后 72 小时和 90 天时超声心动图测量的 RV：LV。次要终点为 90 天时 SF-36 健康调查评估的 QoL 评分、90 天时心肺运动试验（CPET）参数以及肺动脉压（PAP）反应和程序并发症等程序结果。
2013 年 6 月 17 日至 2014 年 9 月 15 日期间，25 例患者接受了治疗，超声心动图显示 RV：LV 平均从就诊时的 1.38±0.28 降至 72 小时时的 0.92±0.14（P<.0001）和 90 天时的 0.84±0.25（P<.0001）。SF-36 健康调查评分显示，PE 未导致长期自我感知的身体或精神不良影响。90 天时 CPET 参数，包括 VO2、体重校正的 VO2、VE/VCO2 和 VD/VT 均未显示肺血管损害。USAT 后 PAP 显著改善，初始收缩压平均值从 50.46±13.98mmHg 降至 39.64±8.66mmHg（P=.0001）。无死亡、复发性静脉血栓栓塞、血流动力学失代偿或出血。
USAT 可在 72 小时内显著降低 RV：LV，90 天时仍可保持。该人群 90 天时 QoL 和心肺功能的客观测量均保持良好。需要进一步的长期随访研究来确定 USAT 在预防亚大块 PE 患者出现 PE 后综合征方面的潜在价值。
