Real-time risk stratification of patients with acute pulmonary embolism by grading the reflux of contrast into the inferior vena cava on computerized tomographic pulmonary angiography
Real-time risk stratification of patients with acute pulmonary embolism by grading the reflux of contrast into the inferior vena cava on computerized tomographic pulmonary angiography
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DOI：
10.1111/j.1538-7836.2008.03079.x
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发表时间：
2008-09-01
影响因子：
10.4
通讯作者：
Berliner, S.
中科院分区：
文献类型：
--
作者：
Aviram, G.;Rogowski, O.;Berliner, S.
目的：研究计算机断层肺血管造影（CTPA）上造影剂返流至下腔静脉（IVC）的快速分级是否是实时风险分层的潜在生物标志物。研究方法：我们回顾性地确定了2004年9月至2006年3月期间在我们的医疗中心接受CTPA检查的343例可能的肺栓塞（PE）患者。共有145例连续PE患者（年龄67 ± 19岁）和168例连续CTPA阴性患者（年龄64 ± 20岁）符合入选标准。使用原始轴位图像，通过1 - 6级快速视觉分级评价CTPA造影剂向IVC的逆行返流。记录肺动脉阻塞指数、左、右心室内径、肺动脉内径及患者生存情况。结果如下：29例（20.0%）CT阳性患者和23例（13.7%）CT阴性患者有明显程度（>= 4）的造影剂返流至IVC（P = 0.14）。Kaplan-Meier 30天生存曲线显示，与较低级别相比，PE和造影剂返流≥ 4级的患者的生存率显著降低（P = 0.008），但在CTPA检查中，≥ 4级且无PE的患者的生存率没有显著降低（P = 0.26）。其他心血管参数与PE和非PE患者的生存率无显著相关性。结论：CTPA期间造影剂向IVC的实质性反流等级可预测急性PE患者的早期死亡率。原始轴位CTPA图像的对比剂反流快速分级可用于急性PE患者的实时风险分层。
Objective: To investigate whether fast grading of reflux of contrast to the inferior vena cava (IVC) on computerized tomographic pulmonary angiography (CTPA) is a potential biomarker for real-time risk stratification. Methods: We retrospectively identified 343 patients investigated for possible pulmonary embolism (PE) by CTPA at our medical center between September 2004 and March 2006. A total of 145 consecutive patients with PE (age 67 +/- 19 years) and 168 consecutive ones with negative CTPAs (age 64 +/- 20 years) fulfilled entry criteria. CTPAs were evaluated for retrograde reflux of contrast to the IVC by fast visual grading from 1 to 6 using the original axial images. Pulmonary obstruction index, the diameters of right and left ventricles and pulmonary artery, and patient survival data were recorded as well. Results: Twenty-nine (20.0%) patients with positive CTs and 23 (13.7%) patients with negative CTs had substantial degrees (>= 4) of reflux of contrast to the IVC (P = 0.14). The Kaplan-Meier 30-day survival curves demonstrated significant reduction in survival in individuals with PE and grade >= 4 reflux of contrast to the IVC compared with lower grades (P = 0.008), but not in patients with grade >= 4 and no PE on CTPA (P = 0.26). The other cardiovascular parameters showed no significant correlation with survival in patients with and without PE. Conclusion: Substantial grades of reflux of contrast to the IVC during CTPA could predict early mortality in patients with acute PE. Rapid grading of reflux of contrast from the original axial CTPA images can be used for real-time risk stratification in patients with acute PE.