Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Massachusetts General Hospital, Boston, Massachusetts.
J Emerg Med. 2021 Feb;60(2):135-143. doi: 10.1016/j.jemermed.2020.09.041. Epub 2020 Oct 27.
Risk stratification of patients with pulmonary embolism (PE) is essential to guide advanced interventional management and proper disposition.
In this study, we sought to assess individual echocardiographic markers of right ventricular (RV) strain and left ventricular (LV) function in patients with high-risk PE and identify their association with the need for advanced intervention (such as thrombolysis) and 30-day mortality.
This was a retrospective study of ED patients with PE who were subject to a pulmonary embolism response team activation over a 5-year period. Cardiac point-of-care ultrasound studies were performed as part of patient care and later assessed for septal bowing, RV hypokinesis, McConnell sign, RV enlargement, tricuspid annular place systolic excursion, and LV systolic dysfunction. Outcome variables included need for advanced intervention and 30-day mortality.
The pulmonary embolism response team was activated in 893 patients, of which 718 had a confirmed PE. Of these, 90 had adequate cardiac point-of-care ultrasound images available for review. Patients who needed an advanced intervention were more likely to have septal bowing (odds ratio [OR] 8.69, 95% confidence interval [CI] 2.37-31.86), RV enlargement (OR 4.02, 95% CI 1.43-11.34), and a McConnell sign (OR 2.79, 95% CI 1.09-7.13). LV dysfunction was the only statistically significant predictor of 30-day mortality (OR 9.63, 95% CI 1.74-53.32).
In patients with PE in the ED, sonographic findings of RV strain that are more commonly associated with advanced intervention included septal bowing, McConnell sign, and RV enlargement. LV dysfunction was associated with a higher 30-day mortality. These findings can help inform decisions about ED management and disposition of patients with PE.
肺栓塞（PE）患者的风险分层对于指导高级介入管理和适当处置至关重要。
本研究旨在评估高危 PE 患者右心室（RV）应变和左心室（LV）功能的个体超声心动图标志物，并确定它们与高级介入（如溶栓）的需求和 30 天死亡率的相关性。
这是一项回顾性研究，纳入了在 5 年内接受 PE 急诊肺部栓塞反应团队激活的 ED 患者。在患者治疗过程中进行了心脏即时超声检查，并对室间隔变形、RV 运动功能减退、McConnell 征、RV 扩大、三尖瓣环收缩期位移和 LV 收缩功能障碍进行评估。主要观察指标为高级介入的需求和 30 天死亡率。
肺部栓塞反应团队在 893 名患者中被激活，其中 718 名患者被确诊为 PE。其中，90 名患者有足够的心脏即时超声图像可供评估。需要高级介入的患者更可能出现室间隔变形（优势比 [OR] 8.69，95%置信区间 [CI] 2.37-31.86）、RV 扩大（OR 4.02，95% CI 1.43-11.34）和 McConnell 征（OR 2.79，95% CI 1.09-7.13）。LV 功能障碍是 30 天死亡率的唯一统计学显著预测因素（OR 9.63，95% CI 1.74-53.32）。
在 ED 中患有 PE 的患者中，与高级介入更相关的 RV 应变的超声心动图发现包括室间隔变形、McConnell 征和 RV 扩大。LV 功能障碍与较高的 30 天死亡率相关。这些发现可以帮助指导 ED 管理和 PE 患者的处置决策。
