Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Sci Rep. 2021 Jan 28;11(1):2450. doi: 10.1038/s41598-021-82038-1.
The aim of our study was to asses the long-term prognostic impact of post-acute, pre-discharge echocardiographic assessment of right ventricular (RV) dysfunction in patients with low- and intermediate-risk pulmonary embolism (PE). Consecutive patients with acute PE underwent post-acute, pre-discharge echocardiographic assessment of RV dysfunction (defined by: RV dilation, tricuspid anulus peak systolic excursion, or tricuspid regurgitation systolic velocity). A Cox multivariate survival mode was constructed to determine the prognostic impact of post-acute, pred-discharge RV dysfunction on all-cause mortality. 615 patients were included: 330 (54%) women, mean age 64 ± 18 years, 265 (43.1%) with post-acute, predischarge RV dysfunction. During follow-up (median 1068 days), 88 (14.3%) patients died. On Cox multivariate analyis, pre-discharge post-acute tricuspid regurgitation systolic velocity emerged as the only independent echocardiographic predictor of mortality (HR 1.73 for every 1 m/s increase; 95% confidence interval 1.033-2.897; p = 0.037). RV dysfunction persists in almost one half of PE patients in the post-acute phase on pre-discharge echocardiography; however, only tricuspid regurgitation systolic velocity independently predicts long-term prognosis.
我们的研究目的是评估急性肺栓塞（PE）低危和中危患者出院前急性后右心室（RV）功能障碍的超声心动图评估对长期预后的影响。连续接受急性 PE 治疗的患者接受了 RV 功能障碍的出院前急性后超声心动图评估（通过 RV 扩张、三尖瓣环收缩期位移或三尖瓣反流收缩期速度来定义）。构建 Cox 多变量生存模型，以确定急性后、预出院 RV 功能障碍对全因死亡率的预后影响。共纳入 615 例患者：330 例（54%）女性，平均年龄 64±18 岁，265 例（43.1%）患者存在急性后、预出院 RV 功能障碍。在随访期间（中位随访时间 1068 天），有 88 例（14.3%）患者死亡。在 Cox 多变量分析中，预出院时急性三尖瓣反流收缩期速度是死亡率的唯一独立超声心动图预测因子（每增加 1m/s 的 HR 为 1.73；95%置信区间为 1.033-2.897；p=0.037）。在出院前的超声心动图上，近一半的 PE 患者在急性后阶段仍存在 RV 功能障碍；然而，只有三尖瓣反流收缩期速度独立预测长期预后。
