Right Atrial To Left Atrial Area Ratio On Early Echocardiography Predict The Long-term Prognosis Of Patients After Acute Pulmonary Embolism

Objective:By studing the relationship between right atrial to left atrial area ratio on early echocardiography and the long-term mortality of patients with acute sub-massive pulmonary embolism(PE) to further investigate its prognosis utility.Methods:Collected 201 patients from December 2010 to January 2014 whom diagnosed by CT pulmonar angiography or ventilation-perfution(V/Q)pulmonary scintifraphy in our hospital. From this group of 201 patients, 125 were diagnosed with acute sub-massive pulmonary embolism. They were in the early onset after transthoracic echocardiography examination, and through formal clinical anticogaulant therapy.All patients with clinical and radiagraphic examination on regular basis, and a telephone follow-up on a regular basis. Parameters on echocardiography include: the ratio of right atrial and left atrial area,the ratio of right ventricular(RV)and left ventricular(LV)end-diastolic diamenters, RV fractional area change, pulmonary artery systolic pressure(PASE),tricuspid annular plane systolic excursion(TAPSE). The clinical outcome include:biochemical laboratory parameters(myocardial markers,brain natriuretic peptide[BNP], D-dimer, C-reactive protein[CRP]) and a simplified Pulmonary Embolus Severity Index(PESI)and given a Charlson Comorbidity Index(CCI) score. All patients were divided into survival group and non-survival group according to the results of the follow-up. To study the ratio of RA and LA area with acute sub-massive pulmonary embolism is influential patients,survival time. Further investigate whether the RA/LA area ratio like CCI scores can independent forecasts of acute sub-massive pulmonary embolism in patients with long-term mortality risk and to study the clinical application value.Results:(1)In the 125 patients, there are 89 cases of survivors and 36 cases of non-survivors over 3.24±0.88 years of follow up. The long-term discharge mortality is 28.8%.(2)General data comparison showed: the age in non-survivors group was older than which in survivors group, more death group of patients with hyperlipidemia, and the difference was statistically significant(P < 0.05).(3)COX-regression analysis of univariate predictors of long-term mortality showed: RA/LA area ratio, plasma concentration of BNP, CCI score, simplified PESI, hyperlipidemia and age, which affect the survival time of patients with acute pulmonary embolism(P<0.05).(4)Multivariate COX-regression analysis showed:RA/LA area ratio(hazrd ratio[HR]: 3.043, 95%confidence interval[CI]: 1.350-6.862), the CCI score(HR: 1.754, 95%CI: 1.039-2.961),the age(HR: 1.139, 95%CI: 1.078-1.203) as independent predictors of long-term mortality with PE patients(P<0.05).(5)Kaplan-Meier survival analysis of RA/LA area ratio divided into tertiles: a RA/LA area ratio >1.04 was associated with significantly worse long-term mortality(P<0.05).(6)K-M survival analysis of a cut-off of RA/LA area ratio=1 adjusted for age, hyperlipidemia, the CCI score?simplified PESI, RV dysfunction and BNP, which revesled: When RA/LA area ratio > 1, the long-term death of acute sub-massive PE with a hazrd ratio of 5.181(P<0.05).Conclusions:Long-term mortality risk in patients with acute pulmonary embolism will increase significantly. RA/LA area ratio on early echocardiography is simple to measure and operate repeatedly, which can independently predicted the risk of long-term mortality of acute sub-massive PE.RA/LA area ratio>1 increased significantly the risk of long-term mortality with PE.