Department of Cardiology, Westchester Medical Center, New York Medical College Valhalla, New York.
Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College Valhalla, New York.
Am J Cardiol. 2023 Aug 15;201:341-348. doi: 10.1016/j.amjcard.2023.06.048. Epub 2023 Jul 4.
In the setting of an acute pulmonary embolism (PE), there is often an assumed association between a saddle PE (SPE) and increased clinical severity. We aimed to determine the magnitude of SPE proximal pulmonary artery (PA) flow obstruction and its impact on right ventricular (RV) function in the setting of acute PE in a single-center series. From 2005 to 2022, patients with acute PE presenting with acute RV dysfunction requiring intervention were classified as SPE and non-SPE based on presenting computed tomography (CT) scans. SPE flow obstruction was determined by the ratio of the orthogonal cross-sectional surface area measurements of clot and native PA at the location of maximum clot burden in the right PA and left PA. Presenting RV function based on clinical and imaging parameters (CT and transthoracic echocardiography) were compared between SPE and non-SPE cohorts. A total of 174 patients were identified (SPE 92 [52.9%] and non-SPE 82 [47.1%]). Demographics and co-morbidities were similar. In patients with SPE, there was a mean 25.9% total flow obstruction (right PA 26.9% and left PA 25.5%). Non-SPE had greater clinical RV dysfunction on presentation as reflected by more high-risk PE (43.9% vs 26.1%, p = 0.01), need for venoarterial extracorporeal membrane oxygenation (21.9% vs 10.9%, p = 0.05), and more preoperative cardiopulmonary resuscitation (16.7% vs 7.8%, p = 0.08). RV:left ventricular ratio (CT and transthoracic echocardiography) and RV fractional area change were statistically similar between groups. In-hospital mortality was statistically similar between cohorts (4.9% non-SPE vs 2.1% SPE, p = 0.32). In conclusion, in a single-center series of patients with acute PE with RV dysfunction, SPE did not cause proximal flow-limiting obstruction. Non-SPE was associated with more clinical RV dysfunction than SPE. Thus, it should not be assumed that a non-SPE is a marker of patient stability.
在急性肺栓塞（PE）的情况下，通常假定鞍状 PE（SPE）与临床严重程度增加之间存在关联。我们旨在确定单一中心系列中急性 PE 情况下 SPE 近端肺动脉（PA）血流阻塞的程度及其对右心室（RV）功能的影响。从 2005 年到 2022 年，因急性 RV 功能障碍需要介入治疗而出现急性 PE 的患者根据初始 CT 扫描分为 SPE 和非 SPE。SPE 血流阻塞通过在右 PA 和左 PA 中血栓最大负荷处测量的血栓和原生 PA 的正交横截面积之比来确定。根据临床和影像学参数（CT 和经胸超声心动图）比较 SPE 和非 SPE 队列之间的初始 RV 功能。共确定了 174 名患者（SPE92[52.9%]和非 SPE82[47.1%]）。人口统计学和合并症相似。在 SPE 患者中，总血流阻塞平均为 25.9%（右 PA26.9%和左 PA25.5%）。非 SPE 在初始时具有更大的临床 RV 功能障碍，表现为更高危的 PE（43.9%比 26.1%，p=0.01），需要静脉动脉体外膜肺氧合（21.9%比 10.9%，p=0.05）和更多术前心肺复苏（16.7%比 7.8%，p=0.08）。CT 和经胸超声心动图上的 RV：左心室比值和 RV 分数面积变化在两组之间统计学上相似。两组之间的住院死亡率统计学上相似（非 SPE4.9%比 SPE2.1%，p=0.32）。总之，在一个有 RV 功能障碍的急性 PE 患者的单一中心系列中，SPE 并没有导致近端血流受限性阻塞。非 SPE 与 SPE 相比，与更多的临床 RV 功能障碍相关。因此，不应假定非 SPE 是患者稳定的标志。
