| Objective: This study is aimed to explore the application value of transthoracic echocardiography（TTE）,computed tomography pulmonary angiography（CTPA）and CT in the evaluation of right ventricular function in patients with pulmonary thromboembolism（PTE）,hoping to provide more choices in imaging diagnosis clinically.Methods: A total of 54 patients with PTE diagnosed by CTPA in the affiliated Hospital of Yunnan University from November 2020 to November 2021 were retrospectively collected as PTE group,and 50 patients suspiciously diagnosed with PTE but negative CTPA in the same period were collected as control group.Patients in PTE group were further divided into the right ventricular dysfunction group（RVD group,n =22）and the non-RVD group（n = 32）according to TTE results.The statistics of the general data,basic diseases,vital signs and laboratory examination of all patients were conducted.Related parameters of right ventricular function of all subjects were measured by CTPA,and the percentage of cross-sectional area of small pulmonary vessels for the lung area（%CSA）was measured by Image J software.Related parameters of right ventricular function of all subjects measured by CTPA and %CSA in PTE group and control group were compared and analyzed.The parameters of right ventricular function measured by TTE,the parameters of right ventricular function measured by CTPA and %CSA in the RVD group and the non-RVD group were compared and analyzed.The correlation analysis of the main pulmonary artery（mPA）diameter and right ventricular diameter/left ventricular diameter（RV/LV）measured by TTE and CTPA was conducted to evaluate the consistency of results measured by TTE and CTPA.Related parameters of right ventricular function measured by TTE and CTPA respectively were obtained using ROC curve to identify the best critical value of RVD,and then its application value was evaluated.Results:（1）There were no significant differences in age,gender,BMI,smoking history,hypertension history and diabetes history between the PTE group and the control group（P>0.05）.（2）The mPA diameter,pulmonary artery to ascending aortic ratio（r PAA）,pulmonary artery to descending aortic ratio（r PDA）,left pulmonary artery（LPA）diameter,right pulmonary artery（RPA）diameter,RV/LV measured by CTPA in the PTE group were higher than those in the control group,and the differences were statistically significant（P<0.05）.%CSA in the PTE group was lower than that in the control group,and the difference was statistically significant（P<0.05）.（3）The proportions of age,hypertension history and diabetes history in the RVD group were higher than those in the non-RVD group（P<0.05）,while the differences in BMI,gender and smoking history between the two groups were not statistically significant（P>0.05）.（4）Compared with the non-RVD group,the %CSA in the RVD group showed a decreasing trend,but the difference was not statistically significant（P>0.05）.（5）Through the comparison of the acceleration time of right ventricular outflow tract（RVOT Ac T）,mPA diameter,right atrial transverse diameter,right atrial area,right ventricular basal segment transverse diameter,tricuspid transvalvular pressure,pulmonary arterial systolic pressure（PASP）,PASP>40mm Hg ratio,inferior vena cava（IVC）inspiratory collapse rate and the proportion of IVC inspiratory collapse rate<50% measured by TTE between the RVD group and the non-RVD group,the differences were statistically significant（P<0.05）.The AUC of RVD predicted by each variable is right atrial area [0.785（95%CI0.641-0.929）],mPA diameter[0.701（95%CI0.546-0.856）],right ventricular basal segment transverse diameter [0.701（95%CI0.540-0.862）] and right atrial transverse diameter[0.668（95%CI0.500-0.835）]from large to small,respectively.（6）There were statistically significant differences between the RVD group and non-RVD group through the comparison of the mPA diameter,r PAA,r PDA,LPA diameter,RPA diameter and RV/LV measured by CTPA（P<0.05）.The AUC of RVD predicted by each variable is mPA diameter [0.784（95%CI0.657-0.911）],RV/LV[0.759（95%CI0.621-0.860）],LPA diameter [0.734（95%CI0.597-0.871）],r PDA[0.73495%CI（0.597-0.871）],r PAA [0.724（95%CI0.578-0.869）] and RPA diameter [0.673（95%CI0.527-0.818）] from large to small,respectively.（7）Among patients with PTE,mPA diameter measured by TTE was positively correlated with mPA diameter measured by CTPA（r=0.571,P<0.001）,and RV/LV measured by TTE was positively correlated with RV/LV measured by CTPA（r=0.558,P<0.001）.Conclusion:（1）The RVOT Ac T,mPA diameter,right atrial transverse diameter,right atrial area,right ventricular basal transverse diameter,tricuspid transvalvular pressure,PASP,IVC inspiratory collapse rate measured by TTE can identify the RVD of patients with PTE.（2）The RV/LV,mPA diameter,r PAA,r PDA,LPA diameter and RPA diameter measured by CTPA can identify the RVD of patients with PTE.（3）The %CSA measured by plain CT scan has reduced among PTE patients,but the RVD for identification purpose has not yet verified in this study. |
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