Jervan Øyvind, Dhayyat Adam, Gleditsch Jostein, Haukeland-Parker Stacey, Tavoly Mazdak, Klok Frederikus A, Rashid Diyar, Stavem Knut, Ghanima Waleed, Steine Kjetil
Department of Cardiology, Østfold Hospital, Kalnes, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Department of Cardiology, Østfold Hospital, Kalnes, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Thromb Res. 2023 Sep;229:7-14. doi: 10.1016/j.thromres.2023.06.004. Epub 2023 Jun 17.
Residual perfusion defects (RPD) after pulmonary embolism (PE) are common.
This study aimed to determine the prevalence of RPD in a cohort diagnosed with PE 6-72 months earlier, and to determine demographic, clinical, and echocardiographic variables associated with RPD.
Patients aged 18-75 years with prior PE, confirmed by computed tomography pulmonary angiography 6-72 months earlier, were included. Participants (N = 286) completed a diagnostic work-up consisting of transthoracic echocardiography and ventilation/perfusion scintigraphy. Demographic, clinical, and echocardiographic characteristics between participants with RPD and those without RPD were explored in univariate analyses using t-test or Mann-Whitney U test. Multiple logistic regression analysis was used to assess the association between selected variables and RPD.
RPD were detected in 72/286 patients (25.2 %, 95 % CI:20.5 %-30.5 %). Greater tricuspid annular plane systolic excursion (TAPSE) (adjusted odds ratio (aOR) 1.10, 95 % CI:1.00-1.21, p = 0.048) at echocardiographic follow-up, greater thrombotic burden at diagnosis, as assessed by mean bilateral proximal extension of the clot (MBPEC) score 3-4 (aOR 2.08, 95 % CI:1.06-4.06, p = 0.032), and unprovoked PE (aOR 2.25, 95 % CI:1.13-4.48, p = 0.021) were independently associated with increased risk of RPD, whereas increased pulmonary artery acceleration time was associated with a lower risk of RPD (aOR 0.72, 95 % CI:0.62-0.83, p < 0.001, per 10 ms). Dyspnoea was not associated with RPD.
RPD were common after PE. Reduced pulmonary artery acceleration time and greater TAPSE on echocardiography at follow-up, greater thrombotic burden at diagnosis, and unprovoked PE were associated with RPD.
肺栓塞（PE）后残留灌注缺损（RPD）很常见。
本研究旨在确定在6 - 72个月前被诊断为PE的队列中RPD的患病率，并确定与RPD相关的人口统计学、临床和超声心动图变量。
纳入年龄在18 - 75岁、6 - 72个月前经计算机断层扫描肺动脉造影确诊为既往有PE的患者。参与者（N = 286）完成了包括经胸超声心动图和通气/灌注闪烁扫描的诊断检查。使用t检验或Mann-Whitney U检验在单变量分析中探讨有RPD和无RPD参与者之间的人口统计学、临床和超声心动图特征。采用多因素逻辑回归分析评估所选变量与RPD之间的关联。
在72/286例患者中检测到RPD（25.2%，95%CI：20.5% - 30.5%）。超声心动图随访时三尖瓣环平面收缩期位移（TAPSE）更大（调整优势比[aOR] 1.10，95%CI：1.00 - 1.21，p = 0.048），诊断时血栓负荷更大，通过血栓平均双侧近端延伸（MBPEC）评分3 - 4评估（aOR 2.08，95%CI：1.06 - 4.06，p = 0.032），以及不明原因的PE（aOR 2.25，95%CI：1.13 - 4.48，p = 0.021）与RPD风险增加独立相关，而肺动脉加速时间增加与RPD风险较低相关（aOR 0.72，95%CI：0.62 - 0.83，p < 0.001，每10毫秒）。呼吸困难与RPD无关。
PE后RPD很常见。随访时超声心动图显示肺动脉加速时间缩短和TAPSE更大、诊断时血栓负荷更大以及不明原因的PE与RPD相关。
