| Objectives:The clinical characteristics,myocardial injury index,echocardiographic index of right heart function and the occurrence of adverse events within 30 days were studied in patients with different thrombus load groups.to explore the effects of pulmonary embolism thrombus load on right heart insufficiency and early adverse events.At the same time,through the grouping study of right heart insufficiency,to find the risk factors of right heart insufficiency in patients with pulmonary embolism,and to further explore the predictive value of right heart insufficiency on early adverse events in patients with pulmonary embolism.Methods:A total of 312 patients with pulmonary embolism who met the inclusion criteria in the Department of Respiratory Medicine,the Second Affiliated Hospital of Kunming Medical University from January 2015 to December 2018 were collected retrospectively.The clot burden of each patient was scored according to the patient's CTPA,and the vital signs,past history,symptoms,lower extremity deep venous thrombosis,myocardial injury markers,echocardiographic right ventricular function indexes and the number of adverse events within 30 days were collected.Compare the differences in the above data between the central embolism group(thrombus load ? 5 groups)and the peripheral embolism group(thrombus load<5 groups).Among them,the central embolization group was compared between the straddle embolization group(thrombotic load=9 points)and the non-straddle embolization group(thrombotic load 5-8 points)to evaluate the right heart function and early dysfunction of different thrombus loads The impact of the incident.In addition,the differences between the general data,markers of myocardial injury,and the number of adverse events in 30 days were compared between the group with right heart insufficiency and those without right heart insufficiency,to find out the risk factors of right heart insufficiency,and to evaluate the right The predictive value of cardiac insufficiency for early adverse events.Results:A total of 312 cases met the inclusion criteria,grouped according to thrombosis load,a total of 104 cases in the central embolization group and 208 cases in the peripheral embolization group.In the central embolization group,there were 23 cases in the straddle embolization group and 81 cases in the non-straddle embolization group.According to the right heart insufficiency group,there were 159 cases with right heart insufficiency and 153 cases without right heart insufficiency.The incidence of right heart insufficiency was about 50.96%.1.Grouped according to CTPA clot burden score1.1 Comparison of general data:There was no statistically significant difference in gender,age and vital signs(P>0.05).In the central embolization group,5 cases(4.81%)had a history of trauma before 1 month,and 1 case(0.96%)had a history of malignant tumors.In the peripheral embolization group,1 case(0.48%)had a history of trauma before 1 month,and 13 cases(0.04%)had a history of malignant tumors.The difference was statistically significant(P<0.05).The central pulmonary embolization group was more likely to have chest pain,lower limb swelling and pain and lower limb deep venous thrombosis.In the central pulmonary embolization group,there were 21 cases of chest pain(20.19%)and 10 cases of lower limb swelling and pain(9.61%).Vascular ultrasound revealed lower limb deep venous thrombosis in 31 cases(29.81%),peripheral embolization group chest pain in 21 cases(10.10%),lower limb swelling and pain in 4 cases(1.92%),lower limb deep venous thrombosis in 36 cases(17.31%).The difference was statistically significant(P<0.05).1.2 Comparison of myocardial injury markers and right heart function parameters:CTnT and NT-ProBNP in the central embolization group were higher than those in the peripheral embolization group,and the difference was statistically significant(P<0.05).Comparison of related parameters of echocardiography:the values of RVDd,RAD,SPAP,TV and the number of RVDd/LVDd>1 in the central embolization group were higher than those in the peripheral embolization group,and the difference was statistically significant(P<0.05).Compared with the non-straddle central embolization group,the CTnT and CK-MB of the straddle embolization group were higher,the difference was statistically significant(P<0.05),but the differences of echocardiographic related parameters were not statistically significant.1.3 Compared with the incidence of adverse events within 30 days,there were 8 cases(7.70%)in the central embolization group and 6 cases(2.88%)in the peripheral embolization group,and there was no significant difference(P>0.05).In the central embolization group,there were 6 cases(26.09%)in the straddle embolization group and 2 cases(2.47%)in the non-straddle embolization group,and the difference was statistically significant(P<0.05)2.According to echocardiogram,group by right heart insufficiency2.1 Comparison of general data:The average age of the group with right heart insufficiency(71.82 ± 11.92)is larger than that of the group without right heart insufficiency(61.52±16.04).The diastolic blood pressure in the group with right heart insufficiency was lower,and the previous history was accompanied by more COPD,and the differences were statistically significant(P<0.05).Right heart insufficiency group was prone to dyspnea and lower limb swelling and pain,the difference was statistically significant(P<0.05).There were no statistically significant differences in syncope,chest pain,fever,hemoptysis and other symptoms,and the probability of being accompanied by deep veins in the lower extremities(P>0.05).2.2 Comparing the markers of myocardial injury,CTnT,MYO,NT-ProBNP and CK-MB in the group with right heart insufficiency were all higher,and the differences were statistically significant(P<0.05).2.3 Thrombus load scores and the incidence of adverse events within 30 days were compared between groups:Thrombotic load score of 4(3-7)points in the group with right heart insufficiency,and 4(2-5)points in the group without right heart dysfunction,the difference was statistically significant(P<0.001);incidence of adverse events There were 12 cases(7.55%)in the group with right heart insufficiency and 2 cases(1.31%)in the group without right heart insufficiency(P<0.05).2.4 Binary logistics regression analysis showed age(OR 1.036,95%CI 1.015-1.058,P=0.001),diastolic blood pressure(OR 0.971,95%CI 0.947-0.995,P=0.017),and without COPD(OR 0.455,95%CI 0.229-0.906,P=0.025),thrombosis load score(OR 1.284,95%CI 1.106-1.492,P=0.001)are the occurrence of pulmonary embolism Influencing factors of right heart dysfunction.Among them,age,suffering from COPD,and thrombus load are risk factors,and diastolic blood pressure is a protective factor.Conclusions:1.Thrombotic load is related to right heart insufficiency,but has no correlation with the occurrence of adverse events within 30 days;2.In central pulmonary embolism,the risk of adverse events within 30 days of straddle pulmonary embolism was higher than that of non-straddle pulmonary embolism.3.Age,suffering from COPD,and thrombosis load are independent risk factors for right heart insufficiency in pulmonary embolism.Among them,thrombus load,and age have predictive value for right heart insufficiency.4.Patients with pulmonary embolism with right heart insufficiency are more likely to experience adverse events early. |
PDF Full Text Request