The Risk Assessment Of Acute Pulmonary Embolism With CT Pulmonary Artery Obstruction Index

Backgrounds and aimsPulmonary embolism(PE)is a clinical syndrome result from endogenous or exogenous embolus which block the pulmonary artery or its branches.How to identify immediately and treat timely has become the focus of present research.With the development of imaging technology,computed tomography pulmonary angiography(CTPA)has become the main diagnostic method in suspected PE.Previous studies have proved CT pulmonary artery obstruction index(PAOI)takes great effect on predicting the prognosis of acute PTE.This study is to investigate the relationship between PAOI and risk stratification of acute pulmonary thromboembolism,and the correlation between PAOI and laboratory or imaging parameters.To explore the value of PAOI in acute PTE.Methods77 consecutive Patients who were first diagnosed with acute PTE were enrolled into our study between January 2013 and January 2017.According to the risk classification of 2014 ESC Guidelines,patients were assigned to low risk group(group A),intermediate-low risk group(group B),intermediate-high risk group and high risk group(group C).To calculate and compare the difference of pulmonary artery obstruction index(PAOI)in different group,further to analyze the relationship of PAOI and clinical data,symptoms and signs,laboratory and imaging parameters.ResultsThe proportion of syncope in group C was significantly higher than that in the other two groups.PaC02 and Oxygenation index were all associated with the severity of acute PE.NT-proBNP and troponin I significantly increase in intermediate-high and high risk groupRVSP、MPA/AA、RV/LV will gradually increase parallel to the risk of acute PE.RVSP and MPA/AA were statistically significant between all groups,RV/LV was statistically significant between group A and group B or group C,however there was no significant statistically difference between group B and group CBoth of Qanadli and Mastora pulmonary artery obstruction index(PAOI)showed an increase trend with the risk of acute PE,Qanadli and Mastora PAOI were positive correlate with pulse rate,DDI,NT-proBNP,cTn I,RV/LV,the extent of correlation coefficient were 0.318～0.526,0.231～0.570,and negative correlate with PaC02,oxygenation index and EF,the range of correlation coefficient were-0.310～-0.368,-0.318～-0.345.Among these parameters,Qanadli and Mastora PAOI was most correlate with cTn I,the correlation coefficient was 0.526 and 0.570.Dividing the study patients into two groups:intermediate-high and high risk group,intermediate-low and low risk group.Both of Qanadli and Mastora PAOI takes a high sensitivity and specificity.Conclusions1.Qanadli and Mastora PAOI were all correlate with the risk of acute PE.Qanadli and Mastora PAOI were correlate well with many clinical parameters2.When the Qanadli PAOI takes a best cutoff of 24%or Mastora PAOI takes a best cutoff of 17%,there is best sensitivity and specificity in distinguish the group of intermediate-high and high risk group with the group of intermediate-low and low risk group.3.There is great clinical significance of computed tomography PAOI in the early assessment of the risk of acute PE and to guide further treatment.