Study The Changes Of Ventricular Function In The 205 Patients With Pulmonary Embolism

Objective:Pulmonary embolism is series of clinical and pathophysiological syndrome caused by embolus obstruction of pulmonary artery or its branch. The clinical presentation is diverse and lack of specificity, including absence of any symptoms and signs to sever shock even sudden death. Myocardial injury and cardiac dysfunction are not only important pathophysiological change of PE,but also the basis of risk stratification.This research through different angles from the different aspect, the myocardial injury caused by pulmonary embolism,cardiac insufficiency by using ultrasonic cardiogram,CT pulmonary arteriography (CTPA),cardiogram,cardiac marker in myocardial injury cardiogram,cardiac marker in myocardial injury and enhance clinician's recognition to the changes of cardiac function after pulmonary embolism, in order to better guide clinical work.Methods: 205 pulmonary embolism patients diagnosed were collected by CTPA, who were hospitalized in the second hospital of Hebei medical university between August 2008 to March 2001. Based on the standard cases from Pulmonary Embolism Diagnose and Treatment Guide issued by Pneumology Branch of Chinese Medical Association in 2001, It analyzed their general information,symptoms and signs,ultrasonic cardiogram,CT pulmonary angiography,cardiogram,cardiac marker in myocardial injury. There were three methods diagnosis of Right ventricular dysfunction: ultrasonic cardiogram,CTPA and cardiogram, and compared with consistence. Results:1. Clinical symptoms of the pulmonary embolism patients1.1 General information205 of pulmonary embolism patients diagnosed by CTPA, includ 131 man,74 female, the age was from 18 to 78 years,the average age was(58±14 years). there was one (0.49%) patients' age<20years,there were 7(3.41%) patients' age in 20-30 years, there were 12(5.85%) patients' age in 30-40 years, there were 45(21.95%) patients' age in 40-50 years, there were 39 (19.02%) patients' age in 50-60 years, there were 52(25.37%) patients' age in 60-70 years,there were 42(20.49%) patients' age in 70-80 years,there were 7(3.41%) patients' age in 80-90 years. there were 90.24% patients' age greater than 40 years, lower than 40 years of patients less than 10%, greater than 80 years only 3.41%.1.2 Risk factorsall of the patients, deep vein thrombosis was the most common in risk factors,had 62 (30.2%)patients.in the next place, 59 patients suffer from hypertension (28.78%), 57(27.80%)patients suffer fromcoronary heart diseases, 34 (20.49%) patients suffer fromcoronarysurgery and wound, 25 (12.20%) patients suffer from diabetes.1.3 Symptoms and signsall of the patients,dyspnea was the most common in symptoms, had 149 patients (72.68%), in the next place, 62 patients(30.24%)appeared thoracalgia. 32 patients (15.61%) appeared apsychia. Only 15 patients (7.32%) appeared triad(dyspnea and thoracalgia and hemoptysis). P2 hyperfunction was the most common in signs, had 87 patients(42.44%), 85 patients(41.46%)appeared short of breath, 61 patients(29.75%)appeared immersionfoot.1.4 Expression of the pulmonary embolism in the ultrasonic cardiogramall of the patients, there were 180 patients(87.80%)who ultrasonic cardiogram had changed. The most common expression: main pulmonary artery diameter dilatation (116 patients,56.59%), pulmonary artery pressure raised(70 patients,34.15%), right ventricular diameter increase(66 patients,32.2%), right atrium diameter increase (61 patients,29.76%), left ventricular diameter reduced (43 patients,20.98%).1.5 Expression of the pulmonary embolism in the CT pulmonary angiography1.5.1 The position of the pulmonary embolismall of the patients,embolism was most common in bilateral(148 patients, 72.2%)and right(187 patients, 91.22%),implicated above pulmonary artery had more patients(168 patients, 81.9%).1.5.2 The change of the pulmonary embolism in the CT pulmonary angiographyall of the patients,the patients who cardiovascular diameter had changed took up 90.73%(186 patients). The main expression were main pulmonary artery diameter dilatation(137 patients, 66.8%),RV short axis to LVshort axis constituent ratios more than 1(99 patients, 48%),right ventricular diameter increase(79 patients, 38.54%),the right ventricular wall thickening(67 patients, 32.68%).1.5.3 The correlation between CT obstruction index and cardiorascular parametersCT obstruction index was(37.48±18.44%).For the correlation between CT obstruction index and RV short axis(r=0.190, P<0.05),RV/LVconstituent ratio(r=0.283, P<0.05),LV short axis(r=-0.212, P<0.05).1.6 The change of the pulmonary embolism in the cardiogram.all of the patients,the patients who cardiogram had changed took up 80.49%(165 patients).The main expression were sinus tachycardia(49 patients, 23.90%),ST-T changed(44 patients, 21.46%),T inversion(39 patients,19.02%),Right axis deviation(30 patients , 14.63%),Clock wise rotation(24 patients, 11.71%).1.7 The change of the pulmonary embolism in the cardiac marker in myocardial injuryLDH increased taken up 56.59%(116 patients), ALT increased taken up 31.71%(65 patients), AST increased taken up 31.22%(64 patients), BNP increased taken up 34.15%(70 patients), NT-proBNP increased taken up 57.6%(118 patients).2. Clinical symptoms of the pulmonary embolism patients accompaniment Right ventricular dysfunctionAll of the patients, 75 the mass/submassive pulmonary embolism patients(36.59%) diagnosed by ultrasonic cardiogram. man 48 patients, female 27 patients, the average age was(57.75±14.81)years. 130nonmassive pulmonary embolism patients(63.41%)man 83 patients,female 47 patients, the average age was(59.52±14.62)years.2.1 Expression in the ultrasonic cardiogramCompared with the nonmassive pulmonary embolism patients,the mass/submassive pulmonary embolism patients of right ventricular diameter increase(2.61±0.48cm vs 1.70±0.24cm,P<0.01), left ventricular diameter reduced(4.57±0.42cm vs 4.86±0.60cm,P<0.01), right atrium diameter increase(4.46±0.77cm vs 3.42±0.53cm,P<0.01), main pulmonary artery diameter dilatation(3.05±0.59cm vs 2.67±0.37cm,P<0.01), pulmonary artery pressure raised(60.61±24.36 mmHg vs 6.57±1.29mmHg,P<0.01). All of the UCG indexes hadsignificant.2.2 Expression in the CT pulmonary angiographyCompared with the nonmassive pulmonary embolism patients, the mass/submassive pulmonary embolism patients of right ventricular diameter increase(4.60±0.77cm vs 3.93±0.62cm,P<0.01), RV short axis to LVshort axis constituent ratios (1.20±0.31 vs 1.01±0.26,P<0.01), the right ventricular wall thickening(0.46±0.17cm vs 0.40±0.11cm,P<0.01), main pulmonary artery diameter dilatation(3.51±0.52cm vs 3.13±0.45cm,P<0.01). All of the CTPA indexes had significant.2.3 Expression in the cardiogramCompared with the nonmassive pulmonary embolism patients,the mass/submassive pulmonary embolism patients of T inversion(25.33% vs 15.38%,P>0.05),sinus tachycardia(26.67% vs 22.31%,P>0.05), Right axis deviation(18.67% vs 12.31%,P>0.05), Clock wise rotation(16.00% vs 9.23%,P>0.05), SⅠQⅢTⅢ(17.33% vs 6.92%,P>0.05).all of the ucg indexes had not significant.2.4 Expression in the cardiac marker in myocardial injuryCompared with the nonmassive pulmonary embolism patients,the mass/submassive pulmonary embolism patients of LDH increased (275.93±155.90U/L vs 270.89±84.81U/L,P > 0.05), ALT increased (62.01±239.51U/L vs 58.10±94.83U/L , P > 0.05), AST increased (47.93±101.74U/L vs 39.73±38.16U/L,P>0.05),had no significant. BNP increased (397.55±96.01pg/ml vs 81.85±10.59pg/ml,P<0.05),NT-proBNP increased (2824.37±455.48pg/ml vs 182.24±15.09pg/ml,P<0.05). BNP and NT-proBNP had significant..3. Compared with consistence in the ultrasonic cardiogram,CTPA and cardiogram of the pulmonary embolism3.1 Compared with consistence in the ultrasonic cardiogram and CTPACTPA diagnostised right ventricular dysfunction had 99 patients(48.29%). In comparison with UCG,diagnostic sensitivity, specificity, positive predictive value and negative predictive value of CTPA were 81.33%, 70.77%, 61.62%, 90.2%, Kappa=0.488, P<0.05(had secondary consistence).3.2 Compared with consistence in the ultrasonic cardiogram and cardiogramCardiogram diagnostised right ventricular dysfunction had 47 patients(22.93%). In comparison with UCG, diagnostic sensitivity, specificity, positive predictive value and negative predictive value of CTPA were 40%, 86.92%, 63.83%, 71.52%, Kappa=0.292, P<0.05(had weak consistence).Conclusion:1.The pulmonary embolism is common among people older than 40 years old but people under 40 years old are not likely to catch this disease. The most common risk factors are deep vein thrombosis, cardiovascular disease, surgery and wound.2.The most common symptoms in the pulmonary embolism is dyspnea and thoracalgia.The most common symptoms in the pulmonary embolism is P2 hyperfunction ,short of breath and immersionfoot.3.The position of the pulmonary embolism is most common in bilateral and right pulmonary artery, and mostly implicated above segment of pulmonary artery.4.The most common expression of the pulmonary embolism in ultrasonic cardiogram are main pulmonary artery diameter dilatation, pulmonary artery pressure raised and right ventricular diameter increase. Accompaniment right ventricular dysfunction patients the most common expression were pulmonary artery pressure raised, right ventricular diameter increase and main pulmonary artery diameter dilatation.5.The most common expression of the pulmonary embolism and the accompaniment right ventricular dysfunction patients in the CT pulmonary angiography are main pulmonary artery diameter dilatation,RV short axisto LV short axis constituent ratios and right ventricular diameter increase.6. There is positive correlation among CT obstruction index,RV short axis and RV/LVconstituent ratio, and there is negative correlation between CT obstruction index and LV short axis.7. The main expression of the pulmonary embolism in the cardiogram are sinus tachycardia, ST-T and T inversion. T inversion, sinus tachycardia and Right axis deviation are the main expression among right ventricular dysfunction patients.8. The pulmonary embolism could change the cardiac marker in myocardial injury.NT-proBNP and BNP are sensitive to the change of right ventricular function.9. Both the ultrasonic cardiogram and CTPA could diagnose right ventricular dysfunction, but cardiogram couldn't.