Gharepapagh Esmaeil, Rahimi Fatemeh, Koohi Ata, Bakhshandeh Hooman, Mousavi-Aghdas Seyed Ali, Sadeghipoor Parham, Fakhari Ashraf, Amirnia Mehrad, Javadrashid Reza, Rashidi Farid
Medical Radiation Sciences Research Team, Tabriz University of Medical Sciences, Tabriz, Iran.
Department of Radiology, Imam Reza Medical Training and Research Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Thorac Res Pract. 2023 Sep;24(5):276-281. doi: 10.5152/ThoracResPract.2023.22160.
A small percentage of acute pulmonary thromboembolisms (PTE) persist as chronic fibrin clots, potentially leading to chronic thromboembolic pulmonary hypertension (CTEPH). A scoring system for evaluating the burden of acute PTE based on computed tomography pulmonary angiogram (CTPA) findings was tested for its association with CTEPH within one year.
In this retrospective cohort of 475 patients with a definitive diagnosis of acute PTE, the Qanadli score (QS) was calculated on the initial CTPA. Through regular follow-up over 1 year, symptomatic patients underwent extensive evaluation.
Of the 475 patients enrolled in the study [age 58.3 ± 16.6, 195 (41.1%) female, QS: 13.01 ± 7.37/40], 321 patients completed the study. A total of 22 (6.8%) patients were definitively diagnosed with CTEPH. In univariate analysis, the initial QS was significantly higher in patients with subsequent CTEPH than in patients without (17 ± 5.6 vs. 13 ± 7.6, P = .009). QS was directly associated with CTEPH (odds ratio: 1.08, 95% confidence interval: 1.0-1.16, P = .042). The evolution of CTEPH in men could be predicted with a sensitivity of 100% and a specificity of 54% when a cut-off point of 14.5 (43.5%) was set for QS. The area under the receiver operating characteristic curve in this setting was 0.74 with a P-value of .032. Qanadli score failed to predict CTEPH in women.
Scoring the clot burden in the pulmonary arteries through the Qanadli method can predict the evolution of CTEPH only in men 1 year after acute PTE. Women comprise most of the CTEPH patients. Thus, strict follow-up adherence seems to be even more important in women.
一小部分急性肺血栓栓塞症（PTE）会持续存在慢性纤维蛋白凝块，可能导致慢性血栓栓塞性肺动脉高压（CTEPH）。基于计算机断层扫描肺动脉造影（CTPA）结果评估急性PTE负担的评分系统，在1年内对其与CTEPH的相关性进行了测试。
在这个对475例确诊急性PTE患者的回顾性队列研究中，根据初始CTPA计算卡纳德利评分（QS）。通过1年的定期随访，有症状的患者接受了全面评估。
在纳入研究的475例患者中[年龄58.3±16.6岁，195例（41.1%）为女性，QS：13.01±7.37/40]，321例患者完成了研究。共有22例（6.8%）患者被确诊为CTEPH。在单因素分析中，后续发生CTEPH的患者初始QS显著高于未发生的患者（17±5.6 vs. 13±7.6，P = 0.009）。QS与CTEPH直接相关（比值比：1.08，95%置信区间：1.0 - 1.16，P = 0.042）。当QS的截断点设定为14.5（43.5%）时，男性CTEPH的进展可被预测，敏感性为100%，特异性为54%。在此情况下，受试者工作特征曲线下面积为0.74，P值为0.032。卡纳德利评分未能预测女性的CTEPH。
通过卡纳德利方法对肺动脉内的凝块负担进行评分，仅能在急性PTE后1年预测男性CTEPH的进展。女性占CTEPH患者的大多数。因此，严格的随访依从性对女性似乎更为重要。
