Clinical and imaging outcomes after intermediate- or high-risk pulmonary embolus.
Clinical and imaging outcomes after intermediate- or high-risk pulmonary embolus.
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DOI：
10.1177/2045894020952019
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发表时间：
2020-07
影响因子：
2.6
通讯作者：
James White R
中科院分区：
文献类型：
--
作者：
Lachant D;Bach C;Wilson B;Chengazi V;Goldman B;Lachant N;Pietropaoli A;Cameron S;James White R
急性肺栓塞后的长期结果从完全消退到慢性血栓栓塞性肺动脉高压(CTEPH)不等。急性肺栓塞后的治疗指南一般仅限于抗凝时间。我们在我们的肺动脉高压诊所对中危或高危急性肺栓塞治疗后2-4个月的患者进行了预后评估。随访时进行呼吸-灌注扫描和超声心动图检查。这项研究的目的是评估急性肺栓塞治疗后复发的症状性疾病、残留的影像缺陷或右室功能障碍以及功能障碍。104例患者在急性中高危肺栓塞治疗后，在肺动脉高压门诊进行了随访。其中，55%的患者自我报告活动受限。无一例出现症状性肺栓塞复发。48%的患者在灌注成像上有残余灌注缺陷，而91%的患者右心室正常或仅有轻微增大。我们发现心力衰竭保留射血分数、铁缺乏和阻塞性睡眠呼吸暂停是导致呼吸困难的重要因素。这些情况的治疗与改善有关。令人惊讶的是，我们在9名患者中诊断出CTEPH；对于一些患者，在指数评估时可能已经存在慢性血栓。我们的发现表明，在急性中危或高危肺栓塞后2-4个月，在专门的肺动脉高压诊所进行随访可能会增加患者护理的价值。我们确定了可治疗的合并症，这些合并症可能与肺栓塞后综合征和CTEPH有关。
Long-term outcomes after acute pulmonary embolism vary from complete resolution to chronic thromboembolic pulmonary hypertension (CTEPH). Guidelines after acute pulmonary embolism are generally limited to anticoagulation duration. We assessed patients with estimated prognosis >1 year in our pulmonary hypertension clinic 2–4 months after treatment for intermediate- or high-risk acute pulmonary embolism. At follow-up, ventilation–perfusion scan and echocardiogram were offered. The aim of this study was to assess for recurrent symptomatic disease, residual imaging defects or right ventricular dysfunction, and functional disability after acute management of pulmonary embolism. After treatment for acute intermediate- or high-risk pulmonary embolism, 104 patients followed up in pulmonary hypertension clinic. Of those, 55% of patients had self-reported limitation in activity. No patients had symptomatic recurrence of pulmonary embolism. Forty-eight percent of patients had residual perfusion defects on perfusion imaging, while 91% of patients had either normal or only mildly enlarged right ventricles. We identified heart failure preserved ejection fraction, iron deficiency, and obstructive sleep apnea as significant contributors to breathlessness. Treatment of these conditions was associated with improvement. Surprisingly, we diagnosed CTEPH in nine patients; for some, chronic thrombus may already have been present at the time of index evaluation. Our findings suggest that follow-up in a dedicated pulmonary hypertension clinic 2–4 months after acute intermediate- or high-risk pulmonary embolism may add value to patient care. We identified treatable comorbidities that could be contributing to post-pulmonary embolism syndrome as well as CTEPH.
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DOI：
10.1016/j.jvscit.2019.07.004
发表时间：
2019-12-01
影响因子：
--
作者：
Bishop, G. Jay;Gorski, Joshua;Cameron, Scott J.
通讯作者：
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影响因子：
3.5
作者：
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影响因子：
158.5
作者：
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影响因子：
8
作者：
Klok, F. A.;Tijmensen, J. E.;Huisman, M. V.
通讯作者：
Huisman, M. V.
DOI：
10.1164/rccm.200506-862oc
发表时间：
2005-10-15
影响因子：
24.7
作者：
Aujesky, D;Obrosky, DS;Fine, MJ
通讯作者：
Fine, MJ