Effect of metabolic syndrome on mean pulmonary arterial pressures in patients with acute pulmonary embolism treated with catheter-directed thrombolysis.
Effect of metabolic syndrome on mean pulmonary arterial pressures in patients with acute pulmonary embolism treated with catheter-directed thrombolysis.
复制标题
代谢综合征对接受导管溶栓治疗的急性肺栓塞患者平均肺动脉压的影响。
DOI：
10.1016/j.ijcard.2019.12.043
复制
发表时间：
2020
影响因子：
3.5
通讯作者：
Kline,JeffreyA
中科院分区：
文献类型：
--
作者：
Stewart,LaurenK;Beam,DarenM;Casciani,Thomas;Cameron,ScottJ;Kline,JeffreyA
背景代谢综合征（MetS）与促凝血和低纤溶状态有关。目前探索 MetS 在静脉血栓栓塞 (VTE) 中的作用的数据有限。目的是测量接受导管定向溶栓 (CDT) 的急性 PE 患者中 MetS 的患病率，并研究其对平均肺动脉压和总体治疗成功的影响。方法我们对患有急性 PE 的 ED 患者进行了为期 3 年的前瞻性登记，这些患者的严重程度符合启动 PE 反应小组 (PERT) 的资格。所有患者均接受 CDT，并采用导管测量 mPAP 和血管造影。根据以下标准从图表审查中提取是否存在 MetS 成分： 1. 体重指数 (BMI) > 30kg/m2； 2.确诊高血压； 3. 糖尿病（包括 HbA1c > 6.5%）； 4.血脂异常（包括甘油三酯>150mg/dL或高密度脂蛋白<40mg/dL）。结果在134名患者中，85%的患者符合四种MetS成分中至少一种的标准，其中肥胖最为常见，占71%。结果表明，无论是纤溶前还是纤溶后，MetS 和 MPAP 标准的数量之间存在正向一致性，因为每增加一个 MetS 标准，压力就会增加。多变量回归分析确定年龄 (-)、BMI (+) 和高血压 (+) 是 mPAP 的显着独立预测变量。结论 MetS 在 PE 表现更严重的患者中很常见，并且与诊断时和 CDT 治疗后较高的 mPAP 值相关。
BackgroundMetabolic syndrome (MetS) has been associated with a procoagulant and hypofibrinolytic state. Current data exploring the role of MetS in venous thromboembolism (VTE) are limited. The objective was to measure the prevalence of MetS in patients with acute PE receiving catheter-directed thrombolysis (CDT) and to investigate its effect on mean pulmonary arterial pressure and overall treatment success.MethodsWe used a 3-year prospective registry of ED patients with acute PE with severity qualifying for activation of a PE response team (PERT). All patients had CDT with catheter-measured mPAP and angiography. The presence or absence of MetS components were extracted from chart review based on the following criteria: 1. body mass index (BMI) > 30 kg/m2; 2. diagnosed hypertension; 3. diabetes mellitus (including HbA1c > 6.5%) and; 4. dyslipidemia (including triglycerides > 150 mg/dL or high-density lipoprotein < 40 mg/dL).ResultsOf the 134 patients, 85% met the criteria for at least one of four MetS components, with obesity being most common, present in 71%. Results demonstrated a positive concordance between the number of criteria for MetS and MPAP, both pre- and post-fibrinolysis, as pressures tended to increase with each additional MetS criterion. Multivariate regression analysis determined age (-), BMI (+) and hypertension (+) to be significant independent predictor variables for mPAP.ConclusionsMetS was common in patients with more severe manifestations of PE and was associated with higher mPAP values both at diagnosis and following treatment with CDT.