Lyhne Mads Dam, Schultz Jacob Gammelgaard, MacMahon Peter J, Haddad Faris, Kalra Mannudeep, Tso David Mai-King, Muzikansky Alona, Lev Michael H, Kabrhel Christopher
Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
Department of Cardiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, Aarhus N, 8200, Aarhus, Denmark.
Emerg Radiol. 2019 Dec;26(6):623-630. doi: 10.1007/s10140-019-01709-9. Epub 2019 Aug 2.
Patients with acute pulmonary embolism (PE) can quickly deteriorate and the condition has high mortality due to right ventricular (RV) failure. Immediately available predictors of adverse outcome are of major interest to the treating physician in the acute setting. The purpose of the present study was to evaluate if easily attainable measurements of RV function from the diagnostic computed tomography pulmonary angiography (CTPA) provide information for fast risk stratification in patients with acute PE.
We retrospectively evaluated images from CTPA in 261 patients (age median 60 years, 50% females) enrolled in a prospective study. RV and left ventricular (LV) diameters and their ratio, the presence of septal bowing, contrast reflux in the inferior vena cava, and the diameter of the central pulmonary arteries (PA) were measured. The composite outcome was 5-day severe adverse events including death, acute decompensation, or need for emergent treatment. We used Wilcoxon rank sum test and Fischer's exact test to test between groups and multivariate logistic regression for prediction.
In multivariate analysis, increased diameter of the main PA (OR = 1.08 per 1 mm increase, p = 0.047) and the presence of septal bowing (OR = 2.23, p = 0.055) were associated with severe adverse events. RV/LV > 1 did not predict severe outcomes (OR = 0.73, p = 0.541).
Two easily attainable parameters of RV function on CTPA, septal bowing and main PA diameter, are associated with short-term adverse outcomes in patients with acute PE. Further study is required to determine whether these findings can be incorporated into clinical treatment algorithms.
急性肺栓塞（PE）患者可能会迅速病情恶化，且由于右心室（RV）衰竭，该病症死亡率很高。在急性情况下，治疗医生对可立即获得的不良预后预测指标非常感兴趣。本研究的目的是评估从诊断性计算机断层扫描肺动脉造影（CTPA）中轻松获得的右心室功能测量值是否能为急性PE患者的快速风险分层提供信息。
我们回顾性评估了261名纳入前瞻性研究患者（年龄中位数60岁，50%为女性）的CTPA图像。测量了右心室和左心室（LV）直径及其比值、室间隔弓背的存在情况、下腔静脉的造影剂反流以及中央肺动脉（PA）的直径。复合结局为5天内的严重不良事件，包括死亡、急性失代偿或需要紧急治疗。我们使用Wilcoxon秩和检验和Fischer精确检验进行组间检验，并使用多因素逻辑回归进行预测。
在多因素分析中，主肺动脉直径增加（每增加1毫米，OR = 1.08，p = 0.047）和室间隔弓背的存在（OR = 2.23，p = 0.055）与严重不良事件相关。右心室/左心室>1不能预测严重结局（OR = 0.73，p = 0.541）。
CTPA上两个易于获得的右心室功能参数，即室间隔弓背和主肺动脉直径，与急性PE患者的短期不良结局相关。需要进一步研究以确定这些发现是否可纳入临床治疗算法。
