2nd Morphofunctional Sciences Department, Biophysics and Medical Physics, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania.
"Neolife" Medical Center, 52 Carol I Avenue, 700503 Iasi, Romania.
Medicina (Kaunas). 2024 Sep 12;60(9):1489. doi: 10.3390/medicina60091489.
: Pulmonary embolism (PE) incidence has been increasing in the last 10 years. Computed thoracic pulmonary angiography (CTPA) had a major role in PE diagnosis and prognosis. The main purpose of this study was as follows: the prognostic value of a CTPA parameter, pulmonary artery obstruction index (PAOI), in PE risk assessment and the predictive accuracy of biomarkers, D-dimer and cardiac Troponin T (c-TnT), in 7-day mortality. A second objective of the research was to investigate the relationship between imaging by PAOI and these biomarkers in different etiologies of PE. : This study comprised 109 patients with PE, hospitalized and treated between February 2021 and August 2022. They had different etiologies of PE: deep vein thrombosis (DVT); persistent atrial fibrillation (AF); chronic obstructive pulmonary disease (COPD) exacerbation; COVID-19; and cancers. The investigations were as follows: clinical examination; D-dimer testing, as a mandatory method for PE suspicion (values ≥500 µg/L were highly suggestive for PE); c-TnT, as a marker of myocardial injury (values ≥14 ng/L were abnormal); CTPA, with right ventricle dysfunction (RVD) signs and PAOI. Treatments were according to PE risk: systemic thrombolysis in high-risk PE; low weight molecular heparins (LWMH) in high-risk PE, after systemic thrombolysis or from the beginning, when systemic thrombolysis was contraindicated; and direct oral anticoagulants (DOAC) in low- and intermediate-risk PE. : PAOI had a high predictive accuracy for high-risk PE (area under curve, AUC = 0.993). D-dimer and cTnT had a statistically significant relationship with 7-day mortality for the entire sample, < 0.001, and for AF, = 0.0036; COVID-19, = 0.003; and cancer patients, = 0.005. PAOI had statistical significance for 7-day mortality only in COVID-19, = 0.045, and cancer patients, = 0.038. The relationship PAOI-D-dimer and PAOI-c-TnT had very strong statistical correlation for the entire sample and for DVT, AF, COPD, and COVID-19 subgroups (Rho = 0.815-0.982). : PAOI was an important tool for PE risk assessment. D-dimer and c-TnT were valuable predictors for 7-day mortality in PE. PAOI (imaging parameter for PE extent) and D-dimer (biomarker for PE severity) as well as PAOI and c-TnT (biomarker for myocardial injury) were strongly correlated for the entire PE sample and for DVT, AF, COPD, and COVID-19 patients.
: 肺栓塞（PE）的发病率在过去 10 年中一直在增加。计算机断层肺动脉造影（CTPA）在 PE 的诊断和预后中有重要作用。本研究的主要目的如下：CTPA 参数肺动脉阻塞指数（PAOI）在 PE 风险评估中的预后价值，以及生物标志物 D-二聚体和心脏肌钙蛋白 T（c-TnT）在 7 天死亡率预测中的准确性。该研究的第二个目的是研究 PAOI 与不同病因 PE 中这些生物标志物之间的关系。 : 本研究纳入了 109 例 PE 住院患者，这些患者于 2021 年 2 月至 2022 年 8 月期间接受治疗。他们的 PE 病因不同：深静脉血栓形成（DVT）；持续性房颤（AF）；慢性阻塞性肺疾病（COPD）加重；COVID-19；和癌症。研究内容如下：临床检查；D-二聚体检测，作为 PE 疑似的强制性方法（≥500μg/L 高度提示 PE）；c-TnT，作为心肌损伤的标志物（≥14ng/L 为异常）；CTPA，伴有右心室功能障碍（RVD）征象和 PAOI。治疗方法根据 PE 风险而定：高危 PE 采用全身溶栓治疗；高危 PE 采用低分子量肝素（LWMH）治疗，全身溶栓后或因全身溶栓禁忌而开始使用 LWMH；低危和中危 PE 采用直接口服抗凝剂（DOAC）。 : PAOI 对高危 PE 有很高的预测准确性（曲线下面积 AUC=0.993）。D-二聚体和 cTnT 与整个样本和 AF、COVID-19、癌症患者的 7 天死亡率有统计学显著关系， < 0.001，和，AF， = 0.0036；COVID-19， = 0.003；癌症患者， = 0.005。PAOI 对 COVID-19 患者和癌症患者的 7 天死亡率有统计学意义， = 0.045 和，癌症患者， = 0.038。PAOI 与 7 天死亡率之间的关系，在整个样本和 DVT、AF、COPD 和 COVID-19 亚组中，D-dimer 和 c-TnT 具有非常强的统计学相关性（Rho=0.815-0.982）。 : PAOI 是评估 PE 风险的重要工具。D-二聚体和 c-TnT 是 PE 死亡率的有价值预测因子。PAOI（PE 范围的影像学参数）和 D-二聚体（PE 严重程度的生物标志物）以及 PAOI 和 c-TnT（心肌损伤的生物标志物）在整个 PE 样本以及 DVT、AF、COPD 和 COVID-19 患者中具有很强的相关性。
