Right ventricular enlargement on chest computed tomography - Prognostic role in acute pulmonary embolism
Right ventricular enlargement on chest computed tomography - Prognostic role in acute pulmonary embolism
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DOI：
10.1161/01.cir.0000129302.90476.bc
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发表时间：
2004-05-25
期刊：
影响因子：
37.8
通讯作者：
Goldhaber, SZ
中科院分区：
文献类型：
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作者：
Quiroz, R;Kucher, N;Goldhaber, SZ
背景-我们研究了多排胸部CT右心室扩大对急性肺栓塞（PE）的预后作用。方法和结果-我们研究了63例CT证实的PE患者，这些患者在随后的24小时内接受了超声心动图检查。24例患者出现不良临床事件，定义为30天死亡率或需要心肺复苏、机械通气、升压药、抢救性溶栓或手术取栓。我们使用轴位和二维重建四腔（4-CH）视图进行了右心室和左心室尺寸（RVD，LVD）的离线CT测量。在有和无不良事件的患者中，轴位视图上RVD/LVD > 0.9的患者比例（70.8%）相似（71.8%; P = 0.577）。相比之下，4-CH视图上RVD/LVD > 0.9在有不良事件的患者中（80.3%）比无不良事件的患者（51.3%; P = 0.015）更常见。预测不良事件的轴位和4-CH视图的RVD/LVD曲线下面积分别为0.667和0.753。RVD/LVD > 0.9预测不良事件的敏感性和特异性在轴位视图上分别为37.5%和92.3%，在重建的4-CH视图上分别为83.3%和48.7%。校正年龄、肥胖、癌症和近期手术后，4-CH视图上RVD/LVD > 0.9是不良事件的独立预测因子（OR，4.02; 95%CI，1.06 - 15.19; P = 0.041）。在识别高危患者方面，从4-CH视图获得的心室CT测量值上级从轴位视图获得的测量值。
Background - We investigated the prognostic role of right ventricular enlargement on multidetector-row chest CT in acute pulmonary embolism ( PE).Methods and Results - We studied 63 patients with CT-confirmed PE who underwent echocardiography within the ensuing 24 hours. Adverse clinical events, defined as 30-day mortality or the need for cardiopulmonary resuscitation, mechanical ventilation, pressors, rescue thrombolysis, or surgical embolectomy, were present in 24 patients. We performed off-line CT measurements of right and left ventricular dimensions (RVD, LVD) with axial and 2-dimensional reconstructed 4-chamber (4-CH) views. The proportion of patients with RVD/LVD > 0.9 on the axial view was similar in patients with (70.8%) and those without adverse events (71.8%; P = 0.577). In contrast, RVD/LVD > 0.9 on the 4-CH view was more common in patients with (80.3%) than without (51.3%; P = 0.015) adverse events. The area under the curve of RVD/LVD from the axial and 4-CH views for predicting adverse events was 0.667 and 0.753, respectively. Sensitivity and specificity of RVD/LVD > 0.9 for predicting adverse events were 37.5% and 92.3% on the axial view and 83.3% and 48.7% on the reconstructed 4-CH view, respectively. RVD/LVD > 0.9 on the 4-CH view was an independent predictor for adverse events (OR, 4.02; 95% CI, 1.06 to 15.19; P = 0.041) when adjusted for age, obesity, cancer, and recent surgery.Conclusions - Right ventricular enlargement on the reconstructed CT 4-CH views predicts adverse clinical events in patients with acute PE. Ventricular CT measurements obtained from 4-CH views are superior to those from axial views for identifying high-risk patients.