The Value Of CTPA And Its Mastora Embolization Index And D-dimer In The Diagnosis Of Acute Pulmonary Embolism

Objective:To evaluate the diagnostic value of Mastora embolism index in CT pulmonary angiography(CTPA)and right heart function parameters in acute pulmonary embolism(APE).To determine whether there was a significant correlation between pulmonary embolism index and D-dimer level using Mastora score;The optimal threshold of D-dimer level for the diagnosis of APE in southern China was determined,and the evaluation of Mastora embolism index,d-dimer and right heart function parameters for the prognosis of APE treatment was also determined.Methods:97 cases(case group)were collected from our hospital from January 2017 to August 2018 due to dyspnea and chest pain,and confirmed APE data in all patients.There were no APE 41 cases(normal control group).The design of APE was evaluated by Mastora APE degree.The degree method was used to calculate the Mastora embolization index,and the case group was divided into two groups of mild and severe obstruction with 21.3% as the cut-off point.1.The basic clinical characteristics of the patients were recorded,and the risk factors and symptoms of APE were analyzed.2.On the CTPA,right ventricular function parameters were recorded,including right ventricular maximum short axis diameter(RVd)and left ventricular maximum short axis diameter(LVd),right ventricle / left ventricular maximum short axis diameter ratio(RVd / LVd),right Atrial maximum short axis diameter(RAd),right ventricular maximum surface area(RVs),left ventricular maximum surface area(LVs),right ventricular/left ventricular maximum surface area ratio(RVs/LVs),main pulmonary artery maximum diameter(MPA),right pulmonary artery Maximum diameter(RPA)and left pulmonary artery maximum diameter(LPA).The differences of right ventricular functional parameters among the groups were analyzed;and inferior vena cava and azygous venous reflux were analyzed in each group.3.The D-dimer level of patients was recorded,and the differences between the case group and the normal control group were compared.The clinical final diagnosis was taken as the standard to analyze the optimal threshold value of Ddimer for the diagnosis of APE in southern population.4.Forty-nine patients were treated and D-dimer and CTPA were reviewed 3 months later.The Mastoro embolization index,D-dimer and right heart function before and after treatment were compared.Results:1.In the case group,the most common risk factor for APE was smoking;the most common clinical symptoms were dyspnea.2.There were significant differences in RVs,LVs,RVd,LVd,RVd / LVd,RVs/LVs and RAd between the case group and the normal control group,and in the case group,RVs,LVs,RVd,LVd,RVd / LVd,There were also significant differences in RVs/LVs and RAd(P<0.05).The D-dimer value in the case group was greater than that in the normal control group,and the severely obstructed grou was larger than the mildly obstruction group in the case group(P<0.05).The inferior vena cava reflux in the severely obstructed group was more than that in the normal control group.the severely obstructed group and the mildly obstruction group had more venous reflux than the normal control group(P<0.05).Spearman correlation analysis showed the best correlation between Mastora embolism index and RVs/LVs(r=0.658,P < 0.001).According to the ROC curve analysis,the maximum AUC was RVd/LVd,which was 0.933(P<0.001).When the RVd/LVd value was 0.99,the diagnosis of APE patients had the best degree of right heart failure,the sensitivity was 80.4%,and the specificity was 100%.3.The Mastora embolization index was greater than 21.3% and was associated with high D-dimer levels.1.4 ug/ml was customized as D-dimer positive,and the clinically confirmed diagnosis was based on the criteria.The specificity of D-dimer for the diagnosis of APE was 68.3%.Spearman correlation analysis showed that Ddimer had the best correlation with RVs/LVs(r=0.458,P<0.001).Based on ROC curve analysis,the optimal threshold for D-dimer level diagnosis of APE in southern China is 1.87ug/ml.4.Before and after APE treatment,the differences between Mastora embolization index,D-dimer and some cardiovascular parameters were statistically significant(P<0.05).Conclusions:1.The extremely significant Mastora embolization index and cardiac changes,reflecting the clinical status were provided by CTPA,reflecting the clinical status and risk classification of APE patients,and providing important references for treatment strategies and patient monitoring.2.High d-dimer value was helpful to assess the severity of APE,and the optimal threshold for d-dimer diagnosis of APE in southern China population may be 1.87ug/ml.3.Mastora embolization index,D-dimer level and right heart function parameters were all helpful to evaluate the therapeutic effect of APE.