Clinical Characteristics Of Patients With Acute Pulmonary Embolism Induced Pulmonary Hypertension

Objective: To analysis the clinical characteristics of the patients with acute pulmonary embolism induced pulmonary hypertension.Methods: The patients with acute pulmonary embolism who were admitted to the second hospital of Hebei medical university from January 2013 to December 2014 were enrolled in this study. The exclusion criteria were as follows. 1.Immune rheumatic disease, heart valvular disease, congenital heart disease, chronic respiratory system disorder, and the patients with pulmonary hypertension caused by a variety of other reasons. 2.Coronary heart disease and other peripheral arterial disease. 3.Severe liver function disorder and renal insufficiency. 4.Refuse to take a pulmonary artery computed tomography angiography(CTA)or echocardiography(UCG). According to the pulmonary artery systolic pressure(PASP) measured by UCG, all the patients were divided into pulmonary hypertension group(APE-PAH group, PASP≥40mm Hg) and pulmonary artery pressure of normal group(normal group, PASP<40mm Hg).Baseline characteristics including gender, age, vital signs, heart rate, respiratory rate, systolic pressure,electrocardiogram(electric axis,, SⅠQⅢTⅢ), UCG(LV,RV, LVEF, E/A, E/e,,TR), lower limb venouitglyceride,pulmonary artery CTA. Biochemical items including alanine aminotransferase(ALT),aspertate aminotransferase(AST),uric acid(UA), creatinine(CREA), uric acid(UA),creatinine(CREA),serum natrium(Na), serum kalium(K),creatine kinase(CK), creatine kinase choline kinase(CKMB), lactic dehydrogenase(LDH), hydroxybutyrate dehydrogenase(HBDH), total cholesterol(CHOL), triglyceride(TG), D-Dimer, prothrombin time(PT), activated partial thromboplastin time(APTT), international normalized ratio( INR), and other indicators were also recorded and compared between the two groups. The incidence of major adverse event in two groups after admission and within 1 month after discharge were also recorded, including right heart failure, hemodynamic disorder,and cardiac death. And SPSS 19.0 software was used to analysis the date between the two groups, and P<0.05 was considered a statistical difference.Result:1 The age in APE-PAH group was higher than that in normal group(64.98±6.50 year vs.60.06±9.73 year, P<0.01). The heart rate in APE-PAH group was higher than that in normal group(88.41±15.60 times/min vs.80.34±15.41 times/min,P<0.01). The systolic blood pressure in APE-PAH group was lower than that in normal group(121.68±18.67 mm Hg vs.128.28±17.36 mm Hg,P<0.05). The other baseline characteristics(ALT, AST, UA, CREA, Na, K, CK,CKMB, LDH, HBDH, CHOL, TG, PT, APTT, INR)between the two groups were similar.2 The right ventricular diameter in APE-PAH group was bigger than that in normal group(28.00±3.73 mm vs.20.88±1.78 mm,P<0.01). There was a significant difference in the level of D-Dimer between the two groups(2.09±0.33ug/ml vs.1.12±0.22ug/ml,P<0.01).3 Electrocardiogram(electric axis, SⅠQⅢTⅢ), echocardiography(LV, LVEF, E/A, E/e,), the time between attacked and hospitalized, the major adverse event in hospital had no difference between the two groups.4 Results of logistic regression analysis indicated that age(OR=3.38,95%CI 1.59-10.19, P=0.003), right ventricular diameter(OR=17.85,95%CI 1.61-113.77,P=0.006), and systolic blood pressure(OR=0.34,95%CI 0.13-0.95,P=0.038)were risk factors for acute pulmonary embolism and pulmonary hypertension.Conclusion:1 Patients with acute pulmonary embolism induced pulmonary hypertension has the following clinical features: the old age, the fast heat rate, the high level of D-Dimer, the low systolic blood pressure, the big right ventricular diameter.2 Age, right ventricular diameter, and systolic blood pressure could be the predictors for acute pulmonary embolism induced pulmonary hypertension.