Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, NC, USA.
Memorial Regional Medical Center, Mechanicsville, VA, USA.
Crit Care. 2022 Jun 4;26(1):160. doi: 10.1186/s13054-022-04030-z.
We determine the predictive value of transthoracic echocardiographic (TTE) metrics for clinical deterioration within 5 days in adults with intermediate-risk pulmonary embolism (PE).
This was a prospective observational study of intermediate-risk PE patients. To determine associations of TTE and clinical predictors with clinical deterioration, we used univariable analysis, Youden's index for optimal thresholds, and multivariable analyses to report odds ratios (ORs) or area under the curve (AUC).
Of 306 intermediate-risk PE patients, 115 (37.6%) experienced clinical deterioration. PE patients who had clinical deterioration within 5 days had greater baseline right ventricle (RV) dilatation and worse systolic function than the group without clinical deterioration as indicated by the following: RV basal diameter 4.46 ± 0.77 versus 4.20 ± 0.77 cm; RV/LV basal width ratio 1.14 ± 0.29 versus 1.02 ± 0.24; tricuspid annular plane systolic excursion (TAPSE) 1.56 ± 0.55 versus 1.80 ± 0.52 cm; and RV systolic excursion velocity 10.40 ± 3.58 versus 12.1 ± 12.5 cm/s, respectively. Optimal thresholds for predicting clinical deterioration were: RV basal width 3.9 cm (OR 2.85 [1.64, 4.97]), RV-to-left ventricle (RV/LV) ratio 1.08 (OR 3.32 [2.07, 5.33]), TAPSE 1.98 cm (OR 3.3 [2.06, 5.3]), systolic excursion velocity 10.10 cm/s (OR 2.85 [1.75, 4.63]), and natriuretic peptide 190 pg/mL (OR 2.89 [1.81, 4.62]). Significant independent predictors were: transient hypotension 6.1 (2.2, 18.9), highest heart rate 1.02 (1.00, 1.03), highest respiratory rate 1.02 (1.00, 1.04), and RV/LV ratio 1.29 (1.14, 1.47). By logistic regression and random forest analyses, AUCs were 0.80 (0.73, 0.87) and 0.78 (0.70, 0.85), respectively.
Basal RV, RV/LV ratio, and RV systolic function measurements were significantly different between intermediate-risk PE patients grouped by subsequent clinical deterioration.
我们确定经胸超声心动图（TTE）指标对成人中危肺栓塞（PE）患者 5 天内临床恶化的预测价值。
这是一项对中危 PE 患者进行的前瞻性观察性研究。为了确定 TTE 和临床预测因素与临床恶化的关联，我们使用单变量分析、Youden 指数的最佳阈值以及多变量分析来报告比值比（OR）或曲线下面积（AUC）。
在 306 例中危 PE 患者中，有 115 例（37.6%）出现了临床恶化。与未发生临床恶化的患者相比，5 天内发生临床恶化的 PE 患者的基线右心室（RV）扩张和收缩功能更差，具体表现为：RV 基底直径 4.46±0.77cm 与 4.20±0.77cm；RV/LV 基底宽度比 1.14±0.29 与 1.02±0.24；三尖瓣环平面收缩期位移（TAPSE）1.56±0.55cm 与 1.80±0.52cm；RV 收缩期位移速度 10.40±3.58cm/s 与 12.1±12.5cm/s。预测临床恶化的最佳阈值为：RV 基底宽度 3.9cm（OR 2.85[1.64, 4.97]）、RV/LV 比值 1.08（OR 3.32[2.07, 5.33]）、TAPSE 1.98cm（OR 3.3[2.06, 5.3]）、收缩期位移速度 10.10cm/s（OR 2.85[1.75, 4.63]）和利钠肽 190pg/ml（OR 2.89[1.81, 4.62]）。显著的独立预测因素有：一过性低血压 6.1（2.2，18.9）、最高心率 1.02（1.00，1.03）、最高呼吸率 1.02（1.00，1.04）和 RV/LV 比值 1.29（1.14，1.47）。通过逻辑回归和随机森林分析，AUC 分别为 0.80（0.73，0.87）和 0.78（0.70，0.85）。
根据随后的临床恶化情况对中危 PE 患者进行分组，发现基线 RV、RV/LV 比值和 RV 收缩功能测量值存在显著差异。
