Acar Emrah, Izci Servet, Inanir Mehmet, Yilmaz Mehmet F, Izgi Ibrahim A, Gokce Mustafa, Kirma Cevat
Department of Cardiology, Gumushane State Hospital, Gumushane, Turkey.
Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey.
J Clin Ultrasound. 2020 Jun;48(5):254-262. doi: 10.1002/jcu.22825. Epub 2020 Apr 1.
Acute pulmonary embolism (APE) is a life-threating cardiothoracic thromboembolic emergency in which right ventricle dysfunction (RVD) is a major concern. In the present study, we examined the hepatic veins (HVs) blood flow with pulsed-wave spectral Doppler ultrasonography to determine its relationship with the simplified pulmonary embolism severity index (sPESI) and the patient's RVD status.
We divided the 243 patients who met the inclusion criteria into two groups based on both their sPESI scores and their RVD status. Transthoracic echocardiography was performed to evaluate the RVD and the HVs within 1 hour after patient admission. The liver was evaluated using subcostal and intercostal echocardiographic windows in grayscale B-mode, and HVs were assessed using color and spectral Doppler assessment though the same echocardiographic windows.
A cut-off value of the systolic reverse flow velocity-time integral (SrVTI) = 2.2 cm carried a sensitivity and specificity of 84.29% and 74.89%, respectively, for the prediction of sPESI ≥ 1. A SrVTI cut-off value of 2.1 cm yielded a sensitivity and specificity of 83.03% and 73.91%, respectively, for the prediction of RVD.
HV Doppler assessment could be a useful method for anticipating the sPESI and the presence of RVD in patients with APE. In addition, it may provide information regarding the hemodynamic impact of APE.
急性肺栓塞（APE）是一种危及生命的心胸血栓栓塞性急症，其中右心室功能障碍（RVD）是主要关注点。在本研究中，我们用脉冲波频谱多普勒超声检查肝静脉（HVs）血流，以确定其与简化肺栓塞严重程度指数（sPESI）及患者RVD状态的关系。
我们根据sPESI评分和RVD状态将243例符合纳入标准的患者分为两组。患者入院后1小时内进行经胸超声心动图检查，以评估RVD和HVs。使用肋下和肋间超声心动图窗口以灰阶B模式评估肝脏，通过相同的超声心动图窗口使用彩色和频谱多普勒评估HVs。
收缩期反向血流速度时间积分（SrVTI）=2.2 cm的截断值对预测sPESI≥1的敏感性和特异性分别为84.29%和74.89%。SrVTI截断值为2.1 cm时，对预测RVD的敏感性和特异性分别为83.03%和73.91%。
肝静脉多普勒评估可能是预测APE患者sPESI及RVD存在情况的有用方法。此外，它可能提供有关APE血流动力学影响的信息。
