Computed Tomography and Echocardiography in Patients With Acute Pulmonary Embolism: Part 2 Prognostic Value
Computed Tomography and Echocardiography in Patients With Acute Pulmonary Embolism: Part 2 Prognostic Value
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DOI：
10.1097/rti.0000000000000048
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发表时间：
2014-01-01
影响因子：
3.3
通讯作者：
Gerhard-Herman, Marie
中科院分区：
文献类型：
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作者：
George, Elizabeth;Kumamaru, Kanako K.;Gerhard-Herman, Marie
目的：比较CT肺动脉造影（CTPA）和经胸超声心动图（TTE）对急性肺栓塞（PE）患者右心室功能不全的预后价值。方法：从2003年8月至2010年5月期间连续行CTPA的1744例急性PE患者中，选择CTPA后48小时内行TTE的785例患者作为研究队列。进行了多变量逻辑回归分析，以评估CTPA RV/左心室（LV）直径比和TTE RV应变与PE相关30天死亡率的相关性，包括作为协变量的其他相关因素。比较了包括CT RV/LV直径比和包括TTE RV应变的模型之间的预测能力（曲线下面积）。结果：CT RV/LV直径比和TTE RV应变与PE相关的30天死亡率独立相关（校正比值比=1.14，P=0.023，CT RV/LV直径比增加0.1;比值比=2.13，P=0.041，TTE RV应变）。充血性心力衰竭和恶性肿瘤病史是PE相关死亡率的独立预测因素，而抗凝治疗相关死亡率显著降低。包括TTE RV应变的模型和包括CT RV/LV的模型具有相似的预测能力（曲线下面积=0.80 vs.0.81，P=0.50）。TTE RV应变和CT RV/LV直径比的敏感性，特异性，阳性和阴性预测值在截止值为1.0是类似的PE相关的30天mortality.Conclusions：TTE RV应变和CT RV/LV直径比增加PE相关的30天死亡率的预测因子具有相似的预后意义。
Purpose:The aim of the study was to compare the prognostic value of right ventricular (RV) dysfunction detected on computed tomography pulmonary angiography (CTPA) and transthoracic echocardiography (TTE) in patients with acute pulmonary embolism (PE).Materials and Methods:From all consecutive CTPAs performed between August 2003 and May 2010 that were positive for acute PE (n=1744), those with TTE performed within 48 hours of CTPA (n=785) were selected as the study cohort. Multivariate logistic regression analysis was performed to assess the association of CTPA RV/left ventricular (LV) diameter ratio and TTE RV strain with PE-related 30-day mortality, including other associated factors as covariates. The predictive ability (area under the curve) was compared between the model including the CT RV/LV diameter ratio and that including TTE RV strain. Test characteristics of the 2 modalities were calculated.Results:Both CT RV/LV diameter ratio and TTE RV strain were independently associated with PE-related 30-day mortality (adjusted odds ratio=1.14, P=0.023 for 0.1 increment of the CT RV/LV diameter ratio; and odds ratio=2.13, P=0.041 for TTE RV strain). History of congestive heart failure and malignancy were independent predictors of PE-related mortality, while there was significantly lower mortality associated with anticoagulation use. The model including TTE RV strain and that including CT RV/LV had similar predictive ability (area under the curve=0.80 vs. 0.81, P=0.50). The sensitivity, specificity, and positive and negative predictive values of TTE RV strain and CT RV/LV diameter ratio at a cutoff of 1.0 were similar for PE-related 30-day mortality.Conclusions:Both RV strain on TTE and an increased CT RV/LV diameter ratio are predictors of PE-related 30-day mortality with similar prognostic significance.