CT肺动脉造影推导的右心室与左心室直径比对急性肺栓塞危险分层及预后的评估价值

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摘要目的分析计算机断层扫描肺动脉造影(CTPA)推导的右心室(RV)与左心室(LV)直径比,对急性肺栓塞(APE)危险分层及预后的预测效能。方法回顾性分析2019-03至2023-04在武警贵州总队医院接受利伐他班预防急性静脉血栓的211例APE患者的电子医疗记录。根据简化版肺栓塞严重指数(sPESI)、肌钙蛋白检测、超声心动图检查将患者分为低危(n=69)、中低危(n=74)、中高危(n=68)。通过超声心动图评估RV收缩功能障碍(RVD),由影像科专家在CTPA图像上垂直于心脏长轴的单次横向扫描中测量RV和LV直径。随访90 d内的不良复合事件发生情况。结果不良结局APE患者的RV/LV更高(P＜0.05),RV/LV预测APE患者短期预后的受试者工作特征曲线下面积(ROCAUC)结果为0.784,在最佳截断值(1.02)处,灵敏度79.9%,特异度75.3%。多元Logistics回归分析结果显示,RV/LV直径比＞1.02为APE患者短期预后不良结局的独立危险因素。中高危患者的RV/LV直径比(1.11±0.25)高于低危(0.96±0.18)及中低危(0.99±0.28)患者(F=7.431,P=0.001)。RV/LV直径比预测中高危APE的ROCAUC为0.780。在RV/LV直径比≤1.02的70例患者中,14例(20.0%)通过超声心动图检测到RVD;在＞1.02的134例患者中,77例(57.46%)通过超声心动图检测到RVD。Spearman秩相关分析结果显示,RV/LV直径比与sPESI(r_s=0.289)、肌酸激酶同工酶(r_s=0.291)、D-二聚体(r_s=0.386)呈正相关。结论根据CTPA推导的RV/LV直径比有助于评估APE患者的危险分层和短期不良预后。

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	马国贤
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关键词 ：计算机断层扫描肺动脉造影, 右心室与左心室直径比, 急性肺栓塞, 危险分层, 预后

Abstract：Objective To analyze the predictive effect of the ratio of right ventricle and left ventricle diameter (RV/LV) derived from computed tomography pulmonary angiography (CTPA) on the risk stratification and prognosis of acute pulmonary embolism (APE). Methods The electronic medical records of 211 APE patients who received rivataban for the prevention of acute venous thrombosis in Guizhou Provincial Corps Hospital of Chinese People’ s Armed Police Force from March 2019 to April 2023 were retrospectively analyzed. According to the simplified pulmonary embolism severity index (sPESI), troponin detection, and echocardiography, the patients were divided into low-risk (n=69), medium-low risk (n=74), and medium-high risk (n=68). RV systolic dysfunction (RVD) was evaluated by echocardiography, in which RV and LV diameters were measured by imaging department experts in a single transverse scan perpendicular to the long axis of the heart on CTPA images. Adverse composite events were followed up within 90 days. Results RV/LV of APE patients with adverse outcomes was significantly higher (P＜0.05), and the area under the subject working characteristic curve (ROCAUC) of RV/LV for predicting short-term prognosis of APE patients was 0.784, with sensitivity of 79.9% and specificity of 75.3% at the optimal cut-off value (1.02). Multivariate logistics regression analysis showed that RV/LV＞1.02 was an independent risk factor for short-term adverse outcome in APE patients. RV/LV (1.11±0.25) in medium-high risk patients was higher than that in low-risk (0.96±0.18) and medium-low risk (0.99±0.28) patients (F=7.431, P=0.001). The ROCAUC for RV/LV predicted APE at high risk was 0.780. Of 70 patients with RV/LV diameter ratio ≤1.02, RVD was detected by echocardiography in 14 (20.0%). Of 134 patients>1.02, RVD was detected by echocardiography in 77 (57.46%) . Spearman rank correlation analysis showed that RV/LV diameter ratio was positively correlated with sPESI (r_s=0.289), creatine kinase Isozyme (r_s=0.291) and D-dimer (r_s=0.386). Conclusions RV/LV diameter ratio derived from CTPA is useful for assessing risk stratification and short-term poor prognosis in patients with APE.

Key words： computed tomography pulmonary angiography diameter ratio of right ventricle to left ventricle acute pulmonary embolism risk stratification prognosis

收稿日期: 2023-11-02

ZTFLH:

R81

作者简介: 马国贤,本科学历,副主任医师。

引用本文:

马国贤, 陈恒, 秦程军. CT肺动脉造影推导的右心室与左心室直径比对急性肺栓塞危险分层及预后的评估价值[J]. 武警医学, 2024, 35(3): 191-196. MA Guoxian, CHEN Heng, QIN Chengjun. Evaluation value of the ratio of right ventricular and left ventricular diameter derived by CT pulmonary angiography on the risk stratification and prognosis of acute pulmonary embolism. Med. J. Chin. Peop. Armed Poli. Forc., 2024, 35(3): 191-196.

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http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2024/V35/I3/191

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