Miller R L, Das S, Anandarangam T, Leibowitz D W, Alderson P O, Thomashow B, Homma S
Department of Medicine, Columbia University, New York, NY, USA.
Chest. 1998 Mar;113(3):665-70. doi: 10.1378/chest.113.3.665.
BACKGROUND/OBJECTIVES: Patients presenting with acute pulmonary embolism associated with hemodynamic compromise exhibit right ventricular enlargement and dysfunction on transthoracic echocardiogram. However, the degree of echocardiographic abnormalities among hemodynamically stable patients without preexisting cardiopulmonary disease during the acute stage of pulmonary embolism, and following treatment, is unknown. Therefore, this study was designed to assess the extent of right ventricular abnormalities detected on transthoracic echocardiogram in patients following acute pulmonary embolism and during treatment with anticoagulation or vena caval interruption. The extent of pulmonary vascular obstruction and complication rate on follow-up were also assessed.
DESIGN/INTERVENTIONS: Sixty-four consecutive hemodynamically stable patients without preexisting known cardiopulmonary disorder presenting with acute pulmonary embolism and undergoing treatment with anticoagulation or inferior vena caval interruption were studied. All subjects underwent a two-dimensional transthoracic echocardiogram within 24 h of diagnosis. The degree of perfusion abnormality on lung scan was quantified. Twenty-six patients underwent follow-up echocardiogram and lung scan at 6 weeks. The echocardiographic findings were compared with those obtained from a group of normal control subjects matched for gender and age.
Although the mean right ventricular end-diastolic areas did not differ (21.9+/-5.2 cm2 vs 20.1+/-2.9 cm2 for control subjects; p=not significant), the right ventricular end-systolic area was larger in comparison to our series of control subjects (14.6+/-5.1 cm2 vs 11.7+/-2.0 cm2; p=0.025). Fractional right ventricular area change was reduced in the patient group compared with the control subjects (34.3+/-9.0% vs 41.3+/-7.0%; p=0.003). The extent of right ventricular end-systolic area enlargement and decrease in fractional area change did not correlate with the degree of pulmonary vascular obstruction. Patients who were restudied at 6 weeks showed minimal improvement in echocardiographic findings, despite almost complete resolution of perfusion defects on lung scan.
The extent of right ventricular dysfunction in hemodynamically stable, previously normal patients with acute pulmonary embolism does not reflect the extent of the perfusion abnormalities. Further, right ventricular enlargement and systolic dysfunction are present and persistent despite treatment with heparin and warfarin therapy or vena caval interruption.
背景/目的：伴有血流动力学障碍的急性肺栓塞患者经胸超声心动图表现为右心室扩大和功能障碍。然而，在肺栓塞急性期且无基础心肺疾病的血流动力学稳定患者中，以及治疗后，超声心动图异常的程度尚不清楚。因此，本研究旨在评估急性肺栓塞患者在接受抗凝治疗或腔静脉阻断治疗期间及之后经胸超声心动图检测到的右心室异常程度。同时还评估了肺血管阻塞程度及随访期间的并发症发生率。
设计/干预措施：对64例连续的、无已知基础心肺疾病、血流动力学稳定且因急性肺栓塞接受抗凝治疗或下腔静脉阻断治疗的患者进行研究。所有受试者在诊断后24小时内接受二维经胸超声心动图检查。对肺扫描的灌注异常程度进行量化。26例患者在6周时接受了随访超声心动图和肺扫描检查。将超声心动图检查结果与一组年龄和性别匹配的正常对照受试者的结果进行比较。
尽管平均右心室舒张末期面积无差异（对照组为21.9±5.2cm²，患者组为20.1±2.9cm²；p无统计学意义），但与我们的对照组相比，患者组的右心室收缩末期面积更大（14.6±5.1cm²对11.7±2.0cm²；p = 0.025）。与对照组相比，患者组的右心室面积变化分数降低（34.3±9.0%对41.3±7.0%；p = 0.003）。右心室收缩末期面积扩大程度和面积变化分数降低与肺血管阻塞程度无关。在6周时再次接受检查的患者，尽管肺扫描上的灌注缺损几乎完全消失，但超声心动图检查结果改善甚微。
血流动力学稳定、既往正常的急性肺栓塞患者右心室功能障碍程度不能反映灌注异常程度。此外，尽管接受了肝素和华法林治疗或腔静脉阻断治疗，但右心室扩大和收缩功能障碍仍然存在且持续存在。
