急性肺栓塞时的左心室收缩功能障碍。

Left ventricular systolic dysfunction during acute pulmonary embolism.

机构信息

Department of Surgery, University of Maryland, Baltimore, MD, USA.

Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.

出版信息

Thromb Res. 2023 Mar;223:1-6. doi: 10.1016/j.thromres.2023.01.011. Epub 2023 Jan 20.

DOI:10.1016/j.thromres.2023.01.011

PMID:36689804

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10989403/

Abstract

BACKGROUND

Heart failure increases the risk of death in acute pulmonary embolism (PE). The role of the left ventricle (LV) in acute PE is not well defined.

OBJECTIVE

To identify the prevalence of LV systolic dysfunction, morphology, and prognosis of the LV during an acute PE.

METHODS

Retrospective study (26-months) of patients diagnosed with an acute PE presenting with LV systolic dysfunction at the University of Maryland.

RESULTS

Among 769 acute PE patients, 78 (10.5 %) had LV systolic dysfunction and 42 (53.8 %) had history of cardiac disease. Patients without history of cardiac disease were younger (mean age [SD] 54.9 [16.8] vs. 62.6 [16.6]; p = 0.04), had a higher BMI (31.2 [12.2] vs. 29.2 [7.7]; p = 0.005), and less hypertension (20 [34.5 %] vs. 38 [65.5 %]; p = 0.0005). A massive PE was most common in patients without history of cardiac disease (8[22.2 %] vs. 2[4.7 %], p = 0.02). There was no difference in clot burden, but right ventricular strain was more frequently seen in patients without history cardiac disease in the initial CT (p = 0.001). The median troponin and lactate were similar in both groups. In 41 patients with follow-up echocardiograms, improvement in LVEF% was observed in patients without cardiac history (median Δ LVEF% [IQR]; 20 [6.2-25.0]). While patients with cardiac disease did not demonstrate similar changes (median Δ LVEF% [IQR]; 0 [-5-17.5]; p = 0.01). In hospital mortality was 12.8 % with no difference between both groups (p = 0.17).

CONCLUSION

Pulmonary embolism can be associated with LV systolic dysfunction, even in patients without history of cardiac disease.

摘要

背景

心力衰竭会增加急性肺栓塞（PE）患者的死亡风险。左心室（LV）在急性 PE 中的作用尚未明确。

目的

明确急性 PE 患者中 LV 收缩功能障碍、形态和 LV 预后的发生率。

方法

这是马里兰大学一项急性 PE 患者的回顾性研究（26 个月），研究对象为 LV 收缩功能障碍患者。

结果

在 769 例急性 PE 患者中，78 例（10.5%）存在 LV 收缩功能障碍，42 例（53.8%）有心脏病史。无心脏病史的患者更年轻（平均年龄[标准差]54.9[16.8]岁比 62.6[16.6]岁；p=0.04），BMI 更高（31.2[12.2]kg/m²比 29.2[7.7]kg/m²；p=0.005），高血压更少（20[34.5%]例比 38[65.5%]例；p=0.0005）。无心脏病史的患者中更常见巨大 PE（8[22.2%]例比 2[4.7%]例；p=0.02）。两组的血栓负荷无差异，但初始 CT 中无心脏病史的患者更常出现右心室应变（p=0.001）。两组患者的肌钙蛋白和乳酸中位数相似。在 41 例接受了随访超声心动图的患者中，无心脏病史患者的 LVEF%有改善（中位数 LVEF%改善[IQR]；20[6.2-25.0]）。而有心脏病史患者未见类似变化（中位数 LVEF%改善[IQR]；0[-5-17.5]；p=0.01）。院内死亡率为 12.8%，两组间无差异（p=0.17）。