Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Divisão de Medicina de Emergência do Departamento de Clínica Médica, Ribeirão Preto, SP - Brasil.
Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Divisão de Radiologia do Departamento de Imagens Médicas, Hematologia e Oncologia Clínica, Ribeirão Preto, SP - Brasil.
Arq Bras Cardiol. 2020 Nov;115(5):809-818. doi: 10.36660/abc.20190392.
Acute pulmonary embolism (APE) has a variable clinical outcome. Computed tomography pulmonary angiography (CTPA) is the gold standard for this diagnosis.
To evaluate if the pulmonary vascular volume (PVV) quantified by automated software is a mortality predictor after APE.
Retrospective cohort study where the CTPA imaging of 61 patients with APE was reanalyzed. Pulmonary vascular volume (PVV) and pulmonary volume (PV) were automatically estimated using the Yacta software. We calculated the adjusted PVV by the ratio: PVV(cm3)/PV(liters). Classical prognostic CTPA parameters (clot load index, right ventricle/left ventricle diameter ratio, pulmonary artery/aorta diameter ratio, ventricular septal bowing, pulmonary infarction and reflux of contrast into the hepatic vein) were assessed. The outcome assessed was one-month mortality. We considered a p-value <0.05 as statistically significant.
Seven deaths (11%) occurred at one month among these 61 patients. PVV<23cm3/L was an independent predictor of one-month mortality in the univariate [odds ratio (OR): 26; 95% confidence interval (CI): 3-244; p=0.004] and multivariate analyses [adjusted OR: 19; 95%CI: 1.3-270; p=0.03]. The classical CTPA parameters were not associated with one-month mortality in this sample. The PVV<23cm3/L showed a sensitivity of 86%, a specificity of 82%, a negative predictive value of 94% and a positive predictive value of 64% to identify the patients who died.
PVV<23cm3/L was an independent predictor of one-month mortality after APE. This parameter showed better prognostic performance than other classical CTPA findings. (Arq Bras Cardiol. 2020; 115(5):809-818).
急性肺栓塞（APE）的临床转归存在差异。计算机断层肺动脉造影（CTPA）是该诊断的金标准。
评估自动软件量化的肺血管容积（PVV）是否是 APE 后的死亡率预测指标。
对 61 例 APE 患者的 CTPA 影像学进行回顾性队列研究。使用 Yacta 软件自动估计肺血管容积（PVV）和肺容积（PV）。我们通过计算：PVV（cm3）/PV（升）来计算调整后的 PVV。评估经典的 CTPA 预后参数（栓子负荷指数、右心室/左心室直径比、肺动脉/主动脉直径比、室间隔弯曲、肺梗死和对比剂反流至肝静脉）。评估的结果是一个月的死亡率。我们认为 p 值<0.05 为统计学显著。
61 例患者中有 7 例（11%）在一个月内死亡。在单因素分析中，PVV<23cm3/L 是一个月死亡率的独立预测因素[比值比（OR）：26；95%置信区间（CI）：3-244；p=0.004]和多因素分析[调整 OR：19；95%CI：1.3-270；p=0.03]。在该样本中，经典的 CTPA 参数与一个月死亡率无关。PVV<23cm3/L 对识别死亡患者的敏感性为 86%、特异性为 82%、阴性预测值为 94%和阳性预测值为 64%。
PVV<23cm3/L 是 APE 后一个月死亡率的独立预测因素。该参数的预后性能优于其他经典 CTPA 发现。（Arq Bras Cardiol. 2020; 115(5):809-818）。
