Babes Elena Emilia, Stoicescu Manuela, Bungau Simona Gabriela, Uivarosan Diana, Tit Delia Mirela, Toma Mirela Marioara, Bungau Alexa Florina, Bustea Cristiana
Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania.
Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania.
Diagnostics (Basel). 2022 May 13;12(5):1226. doi: 10.3390/diagnostics12051226.
Accurate estimation of risk with both imaging and biochemical parameters in intermediate risk pulmonary embolism (PE) remains challenging. The aim of the study was to evaluate echocardiographic parameters that reflect right and left heart hemodynamic as predictors of adverse events in intermediate risk PE. This was a retrospective observational study on patients with computed tomography pulmonary angiography diagnosis of PE admitted at Cardiology department of the Clinical Emergency Hospital of Oradea, Romania between January 2018—December 2021. Echocardiographic parameters obtained at admission were studied as predictors of in hospital adverse events. The following adverse outcomes were registered: death, resuscitated cardiac arrest, hemodynamic deterioration and need of rescue thrombolysis. An adverse outcome was present in 50 patients (12.62%). PE related death was registered in 17 patients (4.3%), resuscitated cardiac arrest occurred in 6 patients (1.51%). Another 20 patients (5.05%) required escalation of therapy with thrombolysis and 7 (1.76%) patients developed haemodynamic instability. Echocardiographic independent predictors for in hospital adverse outcome were RV/LV ≥ 1 (HR = 3.599, 95% CI 1.378−9.400, p = 0.009) and VTI ≤ 15 mm (HR = 11.711, 95% CI 4.336−31.633, p < 0.001). The receiver operator curve renders an area under curve for LVOT VTI ≤ 15 mm of 0.792 (95% CI 0.719−0.864, p < 0.001) and for a RV/LV ≥ 1 of 0.746 (95% CI 0.671−0.821, p < 0.001). A combined criterion (LVOT VTI ≤ 15 and RV/LV ≥ 1) showed a positive predictive value of 75% and a negative predictive value of 95% regarding in hospital adverse outcomes. Low LVOT VTI and increased RV/LV are useful for identifying normotensive patients with PE at risk for short term adverse outcomes. Combining an LVOT VTI ≤ 15 cm with a RV/LV ≥ 1 can identify with increased accuracy PE patients with impending risk of clinical deterioration.
利用影像学和生化参数准确评估中度风险肺栓塞（PE）的风险仍然具有挑战性。本研究的目的是评估反映左右心血流动力学的超声心动图参数，作为中度风险PE不良事件的预测指标。这是一项对2018年1月至2021年12月期间在罗马尼亚奥拉迪亚市临床急诊医院心内科住院的经计算机断层扫描肺动脉造影诊断为PE的患者进行的回顾性观察研究。将入院时获得的超声心动图参数作为住院不良事件的预测指标进行研究。记录了以下不良结局：死亡、复苏的心脏骤停、血流动力学恶化和需要抢救性溶栓。50例患者（12.62%）出现不良结局。17例患者（4.3%）记录为PE相关死亡，6例患者（1.51%）发生复苏的心脏骤停。另外20例患者（5.05%）需要升级溶栓治疗，7例患者（1.76%）出现血流动力学不稳定。超声心动图对住院不良结局的独立预测指标为右心室/左心室≥1（HR = 3.599，95%CI 1.378−9.400，p = 0.009）和VTI≤15 mm（HR = 11.711，95%CI 4.336−31.633，p < 0.001）。受试者工作特征曲线显示，左心室流出道VTI≤15 mm的曲线下面积为0.792（95%CI 0.719−0.864，p < 0.001），右心室/左心室≥1的曲线下面积为0.746（95%CI 0.671−0.821，p < 0.001）。联合标准（左心室流出道VTI≤15且右心室/左心室≥1）对住院不良结局的阳性预测值为75%，阴性预测值为95%。低左心室流出道VTI和升高的右心室/左心室有助于识别有短期不良结局风险的血压正常的PE患者。将左心室流出道VTI≤15 cm与右心室/左心室≥1相结合可以更准确地识别有临床恶化迫在眉睫风险的PE患者。
