Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America.
Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States of America.
Int J Cardiol. 2020 Mar 1;302:138-142. doi: 10.1016/j.ijcard.2019.12.043. Epub 2019 Dec 26.
Metabolic syndrome (MetS) has been associated with a procoagulant and hypofibrinolytic state. Current data exploring the role of MetS in venous thromboembolism (VTE) are limited. The objective was to measure the prevalence of MetS in patients with acute PE receiving catheter-directed thrombolysis (CDT) and to investigate its effect on mean pulmonary arterial pressure and overall treatment success.
We used a 3-year prospective registry of ED patients with acute PE with severity qualifying for activation of a PE response team (PERT). All patients had CDT with catheter-measured mPAP and angiography. The presence or absence of MetS components were extracted from chart review based on the following criteria: 1. body mass index (BMI) >30 kg/m; 2. diagnosed hypertension; 3. diabetes mellitus (including HbA1c >6.5%) and; 4. dyslipidemia (including triglycerides >150 mg/dL or high-density lipoprotein <40 mg/dL).
Of the 134 patients, 85% met the criteria for at least one of four MetS components, with obesity being most common, present in 71%. Results demonstrated a positive concordance between the number of criteria for MetS and MPAP, both pre- and post-fibrinolysis, as pressures tended to increase with each additional MetS criterion. Multivariate regression analysis determined age (-), BMI (+) and hypertension (+) to be significant independent predictor variables for mPAP.
MetS was common in patients with more severe manifestations of PE and was associated with higher mPAP values both at diagnosis and following treatment with CDT.
代谢综合征（MetS）与促凝和纤溶活性降低有关。目前探索代谢综合征在接受导管溶栓治疗（CDT）的急性肺栓塞（PE）患者中的作用的数据有限。目的是测量接受 CDT 的急性 PE 患者中代谢综合征的患病率，并探讨其对平均肺动脉压和整体治疗成功率的影响。
我们使用了一项为期 3 年的前瞻性 ED 急性 PE 患者登记研究，其严重程度符合 PE 反应团队（PERT）激活的标准。所有患者均接受 CDT 治疗，并通过导管测量平均肺动脉压和血管造影。根据以下标准从病历回顾中提取代谢综合征成分的存在或缺失：1. 体重指数（BMI）>30kg/m；2. 诊断为高血压；3. 糖尿病（包括 HbA1c>6.5%）；4. 血脂异常（包括甘油三酯>150mg/dL 或高密度脂蛋白<40mg/dL）。
在 134 名患者中，85%至少符合四个代谢综合征成分中的一个标准，其中肥胖最常见，占 71%。结果表明，在溶栓前和溶栓后，代谢综合征标准的数量与平均肺动脉压之间存在正相关性，压力随着每增加一个代谢综合征标准而升高。多变量回归分析确定年龄（-）、BMI（+）和高血压（+）是平均肺动脉压的显著独立预测变量。
代谢综合征在表现更严重的 PE 患者中很常见，并且与诊断时和接受 CDT 治疗后的平均肺动脉压值升高有关。
