Clinical and echocardiographic predictors of mortality in acute pulmonary embolism.
Clinical and echocardiographic predictors of mortality in acute pulmonary embolism.
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DOI：
10.1186/s12947-016-0087-y
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发表时间：
2016-10-28
影响因子：
1.9
通讯作者：
Rajagopal S
中科院分区：
文献类型：
--
作者：
Dahhan T;Siddiqui I;Tapson VF;Velazquez EJ;Sun S;Davenport CA;Samad Z;Rajagopal S
本研究的目的是评估将超声心动图对心功能的定量评估与临床因素相结合来预测急性肺栓塞（PE）患者的预后。使用杜克大学医院数据库确定根据正通气灌注扫描或计算机断层扫描 (CT) 胸部血管造影诊断为急性肺栓塞的患者。其中，69 例在诊断后 24-48 小时内进行了适合离线分析的超声心动图检查。分析的临床特征包括年龄、性别、体重指数、生命体征和合并症。分析的超声心动图参数包括左心室 (LV) 射血分数 (EF)、局部、游离壁和整体 RV 斑点追踪应变、RV 分数面积变化 (RVFAC)、三尖瓣环面收缩期偏移 (TAPSE)、肺动脉加速时间 (PAAT) 和 RV 心肌性能 (Tei) 指数。使用单变量和多变量回归统计分析模型。在 69 名急性 PE 患者中，中位年龄为 55 岁，其中 48% 为女性。中位体重指数 (BMI) 为 27 公斤/平方米。该队列中 29% 的人有癌症病史，非幸存者的癌症患病率显着增加（57% vs 29%，p = 0.02）。与幸存者相比，非幸存者的临床参数（包括心率、呼吸频率、肌钙蛋白 T 水平、活动性恶性肿瘤、高血压和 COPD）较高（p≤≤0.05）。使用单变量分析，与幸存者相比，非幸存者的 NYHA III 级症状、就诊时低氧血症、心动过速、呼吸急促、肌钙蛋白 T 升高、无高血压、活动性恶性肿瘤和慢性阻塞性肺疾病 (COPD) 增加 (p≤≤0.05)。在多变量模型中，调整年龄、性别和收缩压后，发现 RV Tei 指数、整体和游离（侧）壁 RVLS 与生存概率呈负相关（p≤≤0.05）。将右心室功能超声心动图评估与临床参数相结合，可改善急性肺栓塞患者预后的预测。需要更大规模的研究来验证这些发现。
The aim of this study was to evaluate the utility of adding quantitative assessments of cardiac function from echocardiography to clinical factors in predicting the outcome of patients with acute pulmonary embolism (PE). Patients with a diagnosis of acute PE, based on a positive ventilation perfusion scan or computed tomography (CT) chest angiogram, were identified using the Duke University Hospital Database. Of these, 69 had echocardiograms within 24–48 h of the diagnosis that were suitable for offline analysis. Clinical features that were analyzed included age, gender, body mass index, vital signs and comorbidities. Echocardiographic parameters that were analyzed included left ventricular (LV) ejection fraction (EF), regional, free wall and global RV speckle-tracking strain, RV fraction area change (RVFAC), Tricuspid Annular Plane Systolic Excursion (TAPSE), pulmonary artery acceleration time (PAAT) and RV myocardial performance (Tei) index. Univariable and multivariable regression statistical analysis models were used. Out of 69 patients with acute PE, the median age was 55 and 48 % were female. The median body mass index (BMI) was 27 kg/m2. Twenty-nine percent of the cohort had a history of cancer, with a significant increase in cancer prevalence in non-survivors (57 % vs 29 %, p = 0.02). Clinical parameters including heart rate, respiratory rate, troponin T level, active malignancy, hypertension and COPD were higher among non-survivors when compared to survivors (p ≤ 0.05). Using univariable analysis, NYHA class III symptoms, hypoxemia on presentation, tachycardia, tachypnea, elevation in Troponin T, absence of hypertension, active malignancy and chronic obstructive pulmonary disease (COPD) were increased in non-survivors compared to survivors (p ≤ 0.05). In multivariable models, RV Tei Index, global and free (lateral) wall RVLS were found to be negatively associated with survival probability after adjusting for age, gender and systolic blood pressure (p ≤ 0.05). The addition of echocardiographic assessment of RV function to clinical parameters improved the prediction of outcomes for patients with acute PE. Larger studies are needed to validate these findings.
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影响因子：
158.5
作者：
Meyer, Guy;Vicaut, Eric;Konstantinides, Stavros V.
通讯作者：
Konstantinides, Stavros V.
影响因子：
9.6
作者：
Sachdev, Arun;Villarraga, Hector R.;Kane, Garvan C.
通讯作者：
Kane, Garvan C.
影响因子：
3.3
作者：
George, Elizabeth;Kumamaru, Kanako K.;Gerhard-Herman, Marie
通讯作者：
Gerhard-Herman, Marie
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
影响因子：
--
作者：
Jimenez, David;Aujesky, Drahomir;Yusen, Roger D.
通讯作者：
Yusen, Roger D.