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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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

Received: 02 November 2023

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	MA Guoxian
	CHEN Heng
	QIN Chengjun

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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[J]. Med. J. Chin. Peop. Armed Poli. Forc., 2024, 35(3): 191-196.

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http://journal08.magtechjournal.com/Jwk_wjyx/EN/ OR http://journal08.magtechjournal.com/Jwk_wjyx/EN/Y2024/V35/I3/191

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