Jia Dong, Gao Yizhuo
Department of Emergency Medicine, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, China.
Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, China.
J Thromb Thrombolysis. 2021 Jan;51(1):168-175. doi: 10.1007/s11239-020-02136-1.
To evaluate the efficacy of measuring left coronary artery size to predict deterioration in non-high-risk acute pulmonary embolism (PE) patients. This retrospective study enrolled non-high-risk acute PE patients from January 2011 to December 2019. Patient deterioration was defined as the occurrence of adverse events within 30 days of hospital admission. Patients with adverse events were sex- and age-matched to patients without adverse events. Risk stratification was performed. Cross-sectional areas (CSAs) of the left main and left anterior descending (LAD) coronary artery inlets were measured. The main pulmonary artery (MPA) inlet and outlet and MPA LAD plane, which adjoined the LAD in the MPA, were reconstructed. CSAs, perimeters, and hydraulic diameters were measured to evaluate MPA size and deformation. Cardiac volume was also measured. Quantitative parameters were divided into tertiles. After adjustment by risk stratification, univariate and multivariate analyses were performed. Correlations between different parameters were analysed. Seventy-three patients with adverse events were matched to 73 patients without adverse events. The results of the univariate and multivariate analyses revealed that LAD inlet CSAs (middle and high) predicted adverse events (odds ratio: 0.28 and 0.07, 95% confidence interval: 0.10-0.77 and 0.02-0.22, p = 0.013 and < 0.0001). LAD inlet CSA was strongly and negatively correlated with MPA LAD hydraulic diameter and CSA (correlation coefficients: - 0.643 and - 0.604, p < 0.001). LAD inlet CSA measurement would facilitate adverse event prediction in non-high-risk acute PE patients on the basis of risk stratification. The dilated MPA may involve the decrease in LAD inlet CSA.
评估测量左冠状动脉大小对预测非高危急性肺栓塞（PE）患者病情恶化的有效性。这项回顾性研究纳入了2011年1月至2019年12月期间的非高危急性PE患者。患者病情恶化定义为入院后30天内发生不良事件。发生不良事件的患者与未发生不良事件的患者进行性别和年龄匹配。进行风险分层。测量左主干和左前降支（LAD）冠状动脉入口的横截面积（CSA）。重建主肺动脉（MPA）入口和出口以及MPA中与LAD相邻的MPA-LAD平面。测量CSA、周长和水力直径以评估MPA大小和变形。还测量心脏容积。将定量参数分为三分位数。在通过风险分层进行调整后，进行单因素和多因素分析。分析不同参数之间的相关性。73例发生不良事件的患者与73例未发生不良事件的患者进行匹配。单因素和多因素分析结果显示，LAD入口CSA（中、高）可预测不良事件（比值比：0.28和0.07，95%置信区间：0.10 - 0.77和0.02 - 0.22，p = 0.013和<0.0001）。LAD入口CSA与MPA-LAD水力直径和CSA呈强负相关（相关系数：-0.643和-0.604，p < 0.001）。测量LAD入口CSA将有助于在风险分层的基础上对非高危急性PE患者的不良事件进行预测。扩张的MPA可能涉及LAD入口CSA的减小。
