Division of Cardiology, Department of Medicine, New York University School of Medicine, 530 First Ave. Skirball 9R, New York, NY 10016, United States of America.
Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, United States of America.
Thromb Res. 2020 Nov;195:29-34. doi: 10.1016/j.thromres.2020.06.049. Epub 2020 Jul 3.
The right ventricular outflow tract (RVOT) velocity time integral (VTI), an echocardiographic measure of stroke distance, correlates with cardiac index. We sought to determine the prognostic significance of low RVOT VTI on clinical outcomes among patients with acute pulmonary embolism (PE).
We conducted a retrospective review of echocardiograms on Pulmonary Embolism Response Team (PERT) activations at our institution. The main outcome was a composite of death, cardiac arrest, or hemodynamic deterioration.
Of 188 patients, 30 met the combined outcome (16%) and had significantly lower RVOT VTI measurements (9.0 cm v 13.4 cm, p < 0.0001). The AUC for RVOT VTI at a cutoff of 10 cm was 0.78 (95% CI 0.67-0.90) with a sensitivity, specificity, negative predictive value, and positive predictive value of 0.72, 0.81, 0.94, and 0.42, respectively. Fifty-two patients of the cohort were classified as intermediate-high-risk PE and 21% of those met the combined outcome. RVOT VTI was lower among outcome positive patients (7.3 cm v 10.7 cm, p = 0.02).
Low RVOT VTI is associated with poor clinical outcomes among patients with acute PE.
右心室流出道（RVOT）速度时间积分（VTI）是衡量心排量的超声心动图指标，与心指数相关。我们旨在确定急性肺栓塞（PE）患者 RVOT VTI 降低对临床预后的预测意义。
我们对我院肺栓塞反应小组（PERT）激活的超声心动图进行了回顾性分析。主要结局是死亡、心脏骤停或血流动力学恶化的复合结局。
在 188 名患者中，30 名符合联合结局（16%），RVOT VTI 测量值显著降低（9.0cm 比 13.4cm，p<0.0001）。RVOT VTI 截断值为 10cm 时，AUC 为 0.78（95%CI 0.67-0.90），灵敏度、特异性、阴性预测值和阳性预测值分别为 0.72、0.81、0.94 和 0.42。该队列中有 52 名患者被归类为中高危 PE，其中 21%符合联合结局。阳性结局患者的 RVOT VTI 较低（7.3cm 比 10.7cm，p=0.02）。
急性 PE 患者 RVOT VTI 降低与不良临床结局相关。
