O'Corragain Oisin, Alashram Rami, Millio Gregory, Vanchiere Catherine, Hwang John Hojoon, Kumaran Maruti, Dass Chandra, Zhao Huaqing, Panero Joseph, Lakhter Vlad, Gupta Rohit, Bashir Riyaz, Cohen Gary, Jimenez David, Criner Gerard, Rali Parth
Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
Lung India. 2023 Jul-Aug;40(4):306-311. doi: 10.4103/lungindia.lungindia_357_22.
Right ventricular dysfunction (RVD) is a key component in the process of risk stratification in patients with acute pulmonary embolism (PE). Echocardiography remains the gold standard for RVD assessment, however, measures of RVD may be seen on CTPA imaging, including increased pulmonary artery diameter (PAD). The aim of our study was to evaluate the association between PAD and echocardiographic parameters of RVD in patients with acute PE.
Retrospective analysis of patients diagnosed with acute PE was conducted at large academic center with an established pulmonary embolism response team (PERT). Patients with available clinical, imaging, and echocardiographic data were included. PAD was compared to echocardiographic markers of RVD. Statistical analysis was performed using the Student's t test, Chi-square test, or one-way analysis of variance (ANOVA); P < 0.05 was considered statistically significant.
270 patients with acute PE were identified. Patients with a PAD >30 mm measured on CTPA had higher rates of RV dilation (73.1% vs 48.7%, P < 0.005), RV systolic dysfunction (65.4% vs 43.7%, P < 0.005), and RVSP >30 mmHg (90.2% vs 68%, P = 0.004), but not TAPSE ≤1.6 cm (39.1% vs 26.1%, P = 0.086). A weak increasing linear relationship between PAD and RVSP was noted (r = 0.379, P = 0.001).
Increased PAD in patients with acute PE was significantly associated with echocardiographic markers of RVD. Increased PAD on CTPA in acute PE can serve as a rapid prognostic tool and assist with PE risk stratification at the time of diagnosis, allowing rapid mobilization of a PERT team and appropriate resource utilization.
右心室功能障碍（RVD）是急性肺栓塞（PE）患者风险分层过程中的关键组成部分。超声心动图仍是评估RVD的金标准，然而，在CTPA成像上也可见到RVD的表现，包括肺动脉直径（PAD）增加。我们研究的目的是评估急性PE患者中PAD与RVD超声心动图参数之间的关联。
在一个设有肺栓塞应对团队（PERT）的大型学术中心，对诊断为急性PE的患者进行回顾性分析。纳入具有可用临床、影像学和超声心动图数据的患者。将PAD与RVD的超声心动图标志物进行比较。使用学生t检验、卡方检验或单因素方差分析（ANOVA）进行统计分析；P<0.05被认为具有统计学意义。
共确定了270例急性PE患者。CTPA测量的PAD>30mm的患者右心室扩张率更高（73.1%对48.7%，P<0.005）、右心室收缩功能障碍发生率更高（65.4%对43.7%，P<0.005）以及右心室收缩压>30mmHg的比例更高（90.2%对68%，P=0.004），但三尖瓣环平面收缩期位移≤1.6cm的比例差异无统计学意义（39.1%对26.1%，P=0.086）。观察到PAD与右心室收缩压之间存在微弱的线性增加关系（r=0.379，P=0.001）。
急性PE患者中PAD增加与RVD的超声心动图标志物显著相关。急性PE患者CTPA上PAD增加可作为一种快速的预后工具，并有助于诊断时的PE风险分层，从而能够迅速调动PERT团队并合理利用资源。
