Quantitative measures of right ventricular dysfunction by echocardiography in the diagnosis of acute nonmassive pulmonary embolism
Quantitative measures of right ventricular dysfunction by echocardiography in the diagnosis of acute nonmassive pulmonary embolism
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DOI：
10.1016/j.echo.2006.04.037
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发表时间：
2006-10-01
影响因子：
6.5
通讯作者：
Hassager, Christian
中科院分区：
文献类型：
--
作者：
Kjaergaard, Jesper;Schaadt, Bente Krogsgaard;Hassager, Christian
背景资料：经胸超声心动图（M）用于肺栓塞（PE）患者的风险评估，但通过TTE定量测量右心室（RV）大小、压力和功能获得的增量诊断信息尚未得到充分评价。在300例疑似首次非大面积PE的连续患者中，进行了TTE和通气/灌注肺动脉造影。在逻辑回归分析中，在RV解剖结构的测量、RV压力估计以及具有显著诊断信息的全局和局部RV功能的估计中，RV流出加速时间小于89毫秒，RV与左心室直径的比值大于0.78，右心室流出道缩短率小于35%，心电图上右心室应变体征具有独立的、递增的诊断信息（受试者工作特征曲线下面积= 0.81）。如果包括大于4.1 mmol/L的D-二聚体，则曲线下面积增加至0.88。结论：TTE能显著提高PE的预测概率，对PE的鉴别诊断具有重要意义。因此，TTE可被视为疑似PE患者初始诊断检查的组成部分，特别是在明确的诊断成像可用性有限的情况下。
Background: Transthoracic echocardiography (M) is used in the risk assessment of patients with pulmonary embolism (PE), but the incremental diagnostic information from quantitative measures of right ventricular (RV) size, pressure, and function by TTE has yet to be fully evaluated.Methods. In 300 consecutive patients with suspected first nonmassive PE, TTE and ventilation/ perfusion scintigraphy were performed.Results: Among measures of RV anatomy, RV pressure estimates, and estimates of global and regional RV function with significant diagnostic information in a logistic regression analysis, the acceleration time of RV outflow less than 89 milliseconds, the ratio of RV to left ventricular diameter greater than 0.78, RV outflow tract fractional shortening less than 35%, and signs of RV strain on electrocardiogram had independent, incremental diagnostic information (area under the receiver operating characteristics curve = 0.81). If D-dimer greater than 4.1 mmol/L was included, the area under the curve increased to 0.88. The negative and positive predictive values if any 2 of 3 factors in the final model were present were 88% and 70%, respectively.Conclusion: TTE is able to identify differential diagnoses and enhance pretest probability of PE significantly. TTE could therefore be considered as an integral part of the initial diagnostic workup of patients suspected of PE, especially if definitive diagnostic imaging has limited availability.