Khandhar Sameer J, Mehta Mili, Cilia Lindsey, Palevsky Harold, Matthai William, Rivera-Lebron Belinda, Toma Catalin
Perelman School of Medicine, Penn-Presbyterian Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania.
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Catheter Cardiovasc Interv. 2020 Jan;95(1):13-18. doi: 10.1002/ccd.28491. Epub 2019 Sep 9.
To investigate the invasive hemodynamics in patients with intermediate-risk pulmonary embolism (PE) and the change that occurs with catheter-directed thrombolysis (CDT).
Intermediate-risk PE is associated with right ventricular strain and worse outcomes yet the invasive hemodynamics have not been well described.
Ninety-two consecutive patients with intermediate-risk PE referred for CDT at two tertiary medical centers with Pulmonary Embolism Response Teams were included in this prospective cohort study. Hemodynamics at baseline and after CDT therapy was measured. Patients with cardiac index (CI) ≤1.8 L min m were compared to those without shock (CI > 1.8). Linear regression analysis was performed to study the relationship between clinical variables and low CI.
Thirty-seven out of 92 (40%) had a CI less than 1.8 L min m . When comparing the low CI to the normal CI groups, most demographics, vital signs, biomarkers, and PE severity index (PESI) scores were similar. The low CI group had more females and slightly lower systolic blood pressures although still in the normal range (122 vs. 132 mmHg, p = .026). Treatment with CDT was associated with significant improvement in CI, heart rate, and pulmonary artery pressures in both groups. Linear regression analysis did not reveal a strong correlation between CI and noninvasive metrics such as heart rate, blood pressure, or PESI score.
Forty percent of patients with submassive PE had a depressed CI and treatment with CDT lead to hemodynamic improvements. Invasive hemodynamics may help better identify higher risk patients and guide therapy.
研究中度风险肺栓塞（PE）患者的有创血流动力学以及导管定向溶栓（CDT）治疗后的变化。
中度风险PE与右心室应变及更差的预后相关，但有创血流动力学尚未得到充分描述。
本前瞻性队列研究纳入了两家设有肺栓塞反应小组的三级医疗中心连续92例因CDT治疗而转诊的中度风险PE患者。测量基线及CDT治疗后的血流动力学指标。将心脏指数（CI）≤1.8L·min·m²的患者与无休克（CI＞1.8）的患者进行比较。进行线性回归分析以研究临床变量与低CI之间的关系。
92例患者中有37例（40%）的CI小于1.8L·min·m²。将低CI组与正常CI组进行比较时，大多数人口统计学特征、生命体征、生物标志物和PE严重程度指数（PESI）评分相似。低CI组女性更多，收缩压略低，尽管仍在正常范围内（122 vs. 132mmHg，p = 0.026）。两组患者接受CDT治疗后CI、心率和肺动脉压均有显著改善。线性回归分析未显示CI与心率、血压或PESI评分等无创指标之间存在强相关性。
40%的次大面积PE患者存在CI降低，CDT治疗可改善血流动力学。有创血流动力学可能有助于更好地识别高风险患者并指导治疗。
