| Background and objectives: To assess the risk stratification of patients with acute pulmonary embolism rapidly and accurately was paramount in choosing the appropriate treatment strategy. At present, in patients with haemodynamically stable pulmonary embolism, the prognostic value of right ventricular dysfunction( RVD) assessed by multi-detector computerized tomographic angiography(MD-CTPA)has been arousing debate. The purpose of our study was to discuss the prognostic value within 30 days of right ventricular dysfunction( RVD) assessed by multi-detector computerized tomographic angiography(MD-CTPA)in patients with haemodynamically stable pulmonary embolism, and using echocardiography as the reference standard for RVD, we analysised the diagnostic efficiency of RVD detected by MD-CTPA. Meanwhile we analysised the prognostic value within 30 days of Brain Natriuretic Peptide(BNP), troponin I(c Tn I) and other indicators in patients with haemodynamically stable pulmonary embolism and implication of joint detection.Materials and methods: Among a consecutive series of 292 participates for MDCT pulmonary angiography in Sichuan Academy of Medical Sciences?Sichuan Provincial People’s Hospital from June 2013 to June 2014, and their image data and clinical basic information were recorded. According to the inclusion and exclusion criteria, we collected 84 patients. To collect the prognostic information of 84 patients within 30 days, and we set death within 30 days as primary endpoint and secondary outcomes included(1) recurrent pulmonary embolism;(2) haemodynamic collapse: defined as at least one of the following, a) systolic blood pressure <90 mm Hg for at least 15 min, b) need for cathecolamine administration, c)need for endotracheal intubation, d) need for cardiopulmonary resuscitation, e) need for thrombolysis);(3) major bleeding。Clinical adverse outcomes included(1) death from all causes;(2) recurrent pulmonary embolism;(3) haemodynamic collapse:;(4) major bleeding. We retrospectively analyzed the relationship between the ratio of the RV to the LV detected by 128-slice spiral computed tomography and primary or secondary outcomes, and we also analyzed the relationship among the RVD detected by echocardiography, Brain Natriuretic Peptide( BNP), troponin I(c Tn I)and clinical prognosis, meanwhile we evaluated clinically prognostic value in those indicators.Results: 55 cases( 65.5%) had RVD detected by 128-slice spiral computed tomography( MDCT-RVD for short) in 84 patients with haemodynamically stable pulmonary embolism, and that were not related to age, gender and some risk factors. However, It was significant that the patients with RVD on multi-detector computerized tomographic angiography had more signs of clinical severity, such as chest pain, dyspnoea, and hypoxemia(P<0.05). 22 cases(40.0%)of patients who had RVD on MD-CTPA also had RVD on echocardiography, however 3 cases(10.3%)of patients without RVD detected by MD-CTPA had RVD on echocardiography. Compared with those without RVD on MDCT, patients with RVD on MD-CTPA had more frequent echocardiographic RVD(40.0% VS 10.3%, P<0.05),higher c Tn I and higher BNP(P<0.05). During follow-up, 3 cases of MDCT-RVD patients died, however, nobody died in patients without RVD on MD-CTPA, and there were no significant difference between the two types(P>0.05). 34.5% patients with RVD on MD-CTPA and 20.7% patients without RVD on MD-CTPA had clinical adverse outcomes within 30 days, and there were no significant difference between the two types(P>0.05). In univariate logistic regression analysis, clinical adverse outcomes within 30 days were related to echocardiographic RVD, elevated c Tn I levels, elevated BNP levels, heart rate≥110/min, systolic blood pressure<100mm Hg and heart failure, and selecting the method of step by step forward into multivariate logistic regression analysis, we found c Tn I>0.05ng/ml(OR 5.274; 95%CI 1.550-17.946; P=0.08)and BNP>100pg/ml(OR 6.082; 95%CI 1.629-22.710; P=0.07)could independently predict the clinical adverse outcomes.Conclusion: 1. In patients with haemodynamically stable pulmonary embolism, the number of patients with RVD on 128-slice spiral computerized tomographic angiography was larger than patients without RVD, and there were no significant difference in the overall risk of clinical adverse events. The clinical prognosis of patients with RVD on multi-detector computerized tomographic angiography remained to be further study. Therefore, we needed to take other examinations into consideration.2. In the evaluation of short-time prognosis within 30 days of haemodynamically stable pulmonary embolism patients, study indicated that a large number of clinical indicators such as BNP and c Tn I were better indicators, and the joint detection can further improve the prognostic value. |
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