| ObjectiveTo investigate the correlation between thrombus volume in acute pulmonary embolism and CT pulmonary artery obstruction index(PAOI),imaging parameters related to right ventricular function,serological examination indicators and clinical risk stratification by CT pulmonary angiography(CTPA).MethodsThe clinical data of 119 patients diagnosed with acute pulmonary embolism after CTPA examination in our hospital were retrospectively analyzed.Spearman rank correlation test was used to analyze the correlation between thrombus volume and PAOI,right ventricular function related imaging parameters and serological indicators.Receiver operating characteristic(ROC)curve was drawn to compare the efficacy of thrombus volume and Qanadli pulmonary artery obstruction index in evaluating right ventricular dysfunction in patients with acute pulmonary embolism.According to the patient risk stratification standard of the Guidelines for diagnosis,treatment and prevention of Pulmonary thromboembolism formulated by the Chinese Medical Association,the difference of thrombus volume between patients with different risk stratification was analyzed by Mann-Whitney U test.Based on the characteristics of our study,patients with non-massive acute pulmonary embolism were the main subjects,and the Kruskal-Wallis H rank sum test was used to compare the difference of thrombus volume between patients with PAOI of 20% and 40%.Results1.There was a highly positive correlation between thrombus volume and PAOI in acute pulmonary embolism(r=0.890,P < 0.001).2.There was a positive correlation between the thrombus volume and right ventricular function(RVd/LVd)(r=0.573,P < 0.001);there was a positive correlation between thrombus volume and the right ventricular maximum short-axis diameter(RVd)(r=0.388,P < 0.001).There was a positive correlation between thrombus volume and maximum diameter of the main pulmonary trunk(MPAd)(r=0.240,P=0.009).There was a positive correlation between thrombus volume and the ratio of the main pulmonary trunk to the maximum diameter of the ascending aorta(r PA)(r=0.193,P=0.036).3.There was a negative correlation between thrombus volume and serum indicators:neutrophil/lymphocyte ratio(NLR)(r=-0.283,P < 0.05);there was a positive correlation between thrombus volume and D-dimer(D-Di)(r=0.344,P=0.001).There was a negative correlation between platelet count(PLT)and thrombus volume(r=-0.235,P < 0.05).there was a negative correlation between thrombus volume and plateletcrit(PCT)(r=-0.307,P <0.01).There was a positive correlation between thrombus volume and cardiac troponin I(c TNI)(r=0.767,P=0.001).There were no statistically significant correlation between thrombus volume and monocyte/high density lipoprotein ratio(MHR),platelet/lymphocyte ratio(PLR),mean platelet volume(MPV),platelet distribution width(PDW),prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),thrombin time(TT),fibrin degradation product(FDP),N terminal pro B type natriuretic peptide(NT-pro BNP),cholesterol(CHOL),triglyceride(TG),high-density lipoprotein(HDL)and low-density lipoprotein(LDL).4.In the ROC curve of evaluating right ventricular dysfunction,the AUC value of thrombus volume in acute pulmonary embolism was 0.902,which was slightly higher than the AUC value of PAOI(0.873).In ROC curve analysis,the best critical value of embolus volume for evaluating right ventricular dysfunction was 3.65 ml,and the sensitivity,specificity and Youden index of embolus volume were slightly better than those of PAOI.Right ventricular dysfunction can be considered when the volume of embolus is ≥3.65 ml.5.According to the risk stratification criteria of the Guidelines for diagnosis,treatment and Prevention of pulmonary thromboembolism,there was a significant difference in pulmonary embolism thrombus volume between the low risk group and the medium risk group(pulmonary embolism thrombus volume statistic Z =-4.304,P < 0.001).According to the Qanadli pulmonary artery obstruction index,there were significant differences in thrombus volume among the low risk,intermediate risk and high-risk groups(P < 0.001).Conclusions1.There was a good correlation between CTPA thrombus volume and CT pulmonary artery obstruction index,right ventricular function related imaging parameters and serological examination indicators in patients with acute pulmonary embolism.2.Thrombus volume can be used to evaluate the occurrence of right ventricular dysfunction in patients with acute pulmonary embolism,and the evaluating capability is slightly better than Qanadli pulmonary artery obstruction index.3.Thrombus volume can be used for clinical risk stratification in patients with acute pulmonary embolism.CTPA thrombus volume in patients with acute pulmonary embolism is a good indicator to evaluate the severity of the disease and to evaluate the clinical risk stratification. |
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