| Part one The relationship between pulmonary artery and right/left ventricular diameter ratio and poor prognosis at 30-day after acute pulmonary embolism was quantitatively evaluated by CTPAObjective: To quantitatively evaluate the correlation between Pulmonary artery height,volume and right/left ventricular diameter ratio by 256-slice spiral CT and 30-day poor prognosis of acute pulmonary embolism and their value in risk stratification.Methods: A retrospective analysis of 243 patients diagnosed with acute pulmonary embolism who underwent CTPA examination in our hospital from May 2018 to July 2021.A total of 115 males(47.30%)and 128 females(52.70%)were followed up for 30 days,with an average age of66.00(60.00-72.00)years.The control group was a total of 61 patients who received CTPA examination in our hospital during the same period and were confirmed without pulmonary embolism(matched in a ratio of 4:1 according to sex and age),with a mean age of 65.00(53.00-72.00)years,male 28(45.90%)and female 33(54.10%).Poor prognosis was defined as presence of at least one of the following events within 30 days: death,cardiopulmonary resuscitation,endotracheal intubation,demand for vasopressors(more than 5μ g/kg)in patients with systemic hypotension,and reperfusion therapy.Clinical data of patients were collected: Gender,age,BSA,shortness of breath,hemoptysis,chest pain,amaurosis/syncope,heart rate,respiratory rate,lower limbs edema/pain,systolic blood pressure,history of embolism,Recent operation or immobilization,malignant tumor,diabetes,hypertension,TIA and peripheral vascular diseases,smoking history,embolism classification,etc.VR and MPR technology software at Philips EBW 4.5 workstation were used.The maximum diameter of the main pulmonary artery(MPA),aorta(AO),left pulmonary artery(LPA),right pulmonary artery(RPA),height of the pulmonary trunk(PAH),volume(PAV),and the maximum short diameter between the right and left ventricles were measured.The above indexes in the control group,the good prognosis group and the poor prognosis group were compared,and the risk prediction model of the poor prognosis of acute pulmonary embolism was established by multivariate Logistic regression analysis.Results:1.Comparison of clinical data between the control group,the good prognosis group and the poor group: there were significant differences in heart rate,history of recent operation or immobilization,history of cancer,respiratory failure,and smoking among the three groups(P < 0.05);The heart rate of acute pulmonary embolism group with poor prognosis was higher than that of good prognosis group(P < 0.05).The incidence of history of recent operation or immobilization in the group with poor prognosis was significantly higher than that in the group with good prognosis(P < 0.001).2.There were significant differences in MPA/AO,AO,MPA,RPA,LPA,PAV,RVD/LVD ratio and ventricular septal displacement among the three groups(P < 0.05).Compared with the control group,the levels of MPA/AO,MPA,RPA,LPA,PAV,RVD/LVD ratio metrics and the incidence of ventricular septal displacement were significantly increased in the good and bad prognostic groups.The levels of LPA and RVD/LVD ratio metrics in the poor prognosis group were higher than those in the good prognosis group(P <0.05).There was no significant difference in pulmonary artery height(PAH)and vena cava reflux among the three groups.There was no significant difference in the prognosis of PAOI between good and bad groups(P > 0.05).3.After body surface area normalization,there was no significant difference in the value of LPA between good prognosis and poor prognosis(P > 0.05),while RVD/LVD ratio was significantly different between the two groups(P = 0.002).4.Logistic univariate regression analysis showed that heart rate,recent history of surgery or braking,LPA,RVD/LVD were positively correlated with the poor prognosis of acute pulmonary embolism(P < 0.05).Multivariate regression analysis showed that recent history of surgery OR immobility(OR:1.047,95%CI:1.030～7.877,P=0.044)and RVD/LVD(OR:4.734,95%CI:1.023～21.918,P=0.047)were independent predictors of poor outcome.5.ROC curve analysis(AUC=0.633,95%CI:0.532～0.734)of RVD/LVD affecting adverse prognosis showed: The RVD/LVD threshold was 1.11,meaning that patients with acute pulmonary embolism had an increased risk of poor prognosis and a sensitivity of 76.50% when RVD/LVD > 1.11.Conclusions: The pulmonary artery and right and left ventricular diameters in patients with acute pulmonary embolism can be measured objectively by 256-slice spiral CT angiography.The volume of pulmonary trunk(PAV)and Pulmonary artery diameter(MPA,LPA,RPA,MPA/AO)and RVD/LVD ratio have strong diagnostic efficacy for acute pulmonary embolism.RVD/LVD ratio and recent operation or immobilization were independent predictors of poor outcome in patients with acute pulmonary embolism.Part two Quantitative ventricular correlation metrics,laboratory indexes and clinical scores were used to predict early mortality of acute pulmonary embolism by 256-slice spiral CTObjective: To assess the prognostic value of right ventricular size,including diameter,area,and volume,in short-term mortality of acute pulmonary embolism based on 256-slice computed tomography(CT),compared with D-dimer,CK-MB,and Wells scores.To observe the predictive value of imaging CT ventricular related metrics,laboratory indexes and clinical scores in acute pulmonary embolism(APE)short-term mortality.Methods: In this study,a total of 225 patients diagnosed with acute pulmonary embolism who underwent CTPA examination in our hospital from2018.5 to 2021.11 were included for retrospective analysis.A total of 112males(49.80%)and 113 females(50.20%)with a mean age of 63.54(11.00)years were followed up for 30 days with complete data.There were 15 patients in the death group,including 9 males(60.00%).There were 210 patients in the non-death group,including 103 males(49.00%).Clinical data and laboratory indicators(CK,CK-MB and D-dimer)were collected,and Wells scores were calculated.Philips 256-slice spiral CT was used to quantitatively measure the volume of right ventricle(RV)and left ventricle(LV)in the original pulmonary artery CTA data,and calculate the maximum volume ratio of right ventricle to left ventricle(RVV/LVV).The short diameter and cross-sectional area of the right and left ventricles were measured on the transverse image and the reconstructed four-chamber heart,and the maximum short diameter and cross-sectional area ratios(RVD/LVD-ax,RVA/ LVD-Ax and RVD/LVD-4ch,RVA/ LVD-4CH)were calculated.The diameter of the coronary sinus(CS)was measured on the transverse image.The difference between the death and non-death groups was compared,and the risk prediction model of short-term death in patients with acute pulmonary embolism was established by multivariate Logistic regression analysis.Results:1.The active period of cancer,heart rate ≥ 100 beats / min and RVA/LVA-ax were positively correlated with early death from acute pulmonary embolism(P<0.05).However,there were no significant differences in gender,age,pulmonary infection,history of coronary heart disease,previous history of pulmonary embolism or deep vein thrombosis,smoking history,hyperlipidemia,surgery/brake history,hemoptysis and lower limb edema/pain between the two groups(P > 0.05).2.RVD/LVD-ax,RVA/LVA-ax,RVA/LVA-4ch,RVV/LVV,D-dimer,and CK levels were significantly higher in the death group than in the non-death group(P < 0.05).But there were no significant differences in RVD/LVD-4ch,coronary sinus diameter,CK-MB and Wells scores between the death and non-death groups(P > 0.05).3.Univariate Logistic regression analysis showed that the active stage of malignant tumor,heart rate≥100 beats/min and RVA/LVA-ax were positively correlated with the early death of acute pulmonary embolism(P<0.05).Multivariate Logistic regression analysis showed that active stage of malignant tumor(OR:9.247,95%CI:2.682～31.888,P<0.001)and RVA/LVA-ax(OR:3.073,95%CI:1.447～6.528,P = 0.003)was an independent predictor of early death from acute pulmonary embolism.4.According to ROC curve,the AUC of RVA/LVA-ax was 0.690,95%CI:0.555 ～ 0.824.the cut-off point of RVA/LVA-ax was 1.68 with sensitivity of 46.70% and specificity of 84.80%.Conclusion: Using 256-slice spiral CT pulmonary artery imaging,the measurement of ventricular size in the transverse axial plane is more convenient and reliable than that in the reconstructed four-chamber plane.RVA/LVA-ax is the independent predictor of early death of acute pulmonary embolism,and when RVA/LVA-ax > 1.68,the risk of early death of acute pulmonary embolism increases.Part three The correlation between coronary artery calcification score and cardiac structure and 30-day poor prognosis in patients with acute pulmonary embolismObjective: This article aims to explore the relationship between coronary artery calcification score(CACS)and cardiac structure and 30-day adverse prognosis in patients with APE,in an attempt to obtain additional indicators suitable for assessing the risk stratification of acute pulmonary embolism in Chinese.Methods: A retrospective study was conducted on 405 hospitalized patients with acute pulmonary embolism diagnosed by CTPA from August2018 to October 2021.There were 202 males(49.90%)and 203 females(50.10%),with an average age of 65.00(15.00)years.The patients’ smoking history,hypertension history,hyperlipidemia,diabetes,cardiovascular disease and other related clinical data were recorded.On the CTPA axial images,the coronary artery calcification score was calculated using a segmented vascular specific score method,and was divided into four categories: none,mild,moderate,and severe.Quantitative measurement of the short diameter,long diameter,cross-sectional area,and volume of left atrium(LA),right atrium(RA),left ventricle(LV),and right ventricle(RV).Through quantitative comparison and correlation analysis of coronary artery calcification score and CT related metrics of various cardiac structures,the relationship between coronary artery calcification(CAC)and short-term prognosis of APE was obtained.Results:1.In this study,there were 228 patients with acute pulmonary embolism,119 patients with mild APE(52.20%),91 patients with moderate APE(39.90%),and 18 patients with severe APE(7.9%);214 cases(93.90%)were treated with anticoagulation,and 14 cases(6.10%)were treated with thrombolysis/thrombectomy;The prognosis was good in 195 cases(85.50%),and poor in 33 cases(14.50%).2.In 136 patients with APE(59.60%),CAC occurred,including 85 patients with mild calcification(37.30%),31 patients with moderate calcification(13.60%),and 20 patients with severe calcification(8.80%).CAC is most common in left anterior descending.3.There were no significant differences in atrial and ventricular short diameter,long diameter,area,volume,and 30-day adverse prognosis between patients with and without CAC in APE(P > 0.05);The age and incidence rate of hypertension in patients with APE and CAC were significantly higher than those without CAC(P < 0.001).4.The left ventricular length,short diameter,area,volume,and left atrial volume in patients with severe CAC embolism were higher than those in patients with mild to moderate CAC embolism(P < 0.05);There was no significant difference in CT metrics between patients with APE and mild to moderate CAC(P>0.05).Conclusion: This study found that coronary artery calcification is significantly associated with risk factors such as age and hypertension.Patients with APE and severe CAC have left ventricular enlargement and changes in the right ventricular/left ventricular ratio,which affect the accuracy of prognosis evaluation in APE patients and interfere with treatment decisions.Clinical doctors should attach great importance to this group of patients.CAC is not associated with short-term prognosis in patients with APE,and its value in all cause mortality needs to be further explored.Part four Correlation between pulmonary artery blocking index and atrial and ventricular sizes in patients with acute pulmonary embolismObjective: This article uses 256 spiral CT to study the correlation between pulmonary embolism index and atrium and ventricle in patients with acute pulmonary embolism,to explore the changes in cardiac morphology and hemodynamics in patients with APE,and to evaluate their ability to detect early circulatory failure.Methods: A retrospective analysis of 228 patients diagnosed with acute pulmonary embolism who underwent CTPA examination in our hospital.There were 111 males(48.70%)and 117 females(51.30%),with an average age of 66.00(12.00)years.Clinical data such as age,sex,history of diabetes,hypertension,asthma and COPD were recorded.The severity of pulmonary embolism was divided into three levels depending on Pulmonary embolism index(PAOI),mild(PAOI < 40%),Moderate(40%～60%)and Severe(PAOI >60%).The short diameter,long diameter and cross-sectional area of left atrium(LA),right atrium(RA),left ventricle(LV)and right ventricle(RV)were measured on the transverse image of CTPA.The volume of LA,RA,LV and RV was measured by the heart function software.Quantitative comparison and correlation analysis were conducted for each atrial and ventricular CT metrics in APE patients,and the best predictor of early circulatory failure in APE patients was determined by drawing receiver operating characteristic(ROC)curve.Results:1.The incidence of tumor history and poor prognosis in embolization group was significantly higher than that in control group(P < 0.05);Except for RA/LA short diameter ratio and RV area,short diameter,long diameter,area and volume values of RA,RV,RV/LV and RA/LA in pulmonary embolism patients were significantly higher than those in control group(P <0.05).The short diameter,area and volume of LA and LV in embolization group were smaller than those in control group(P < 0.05).2.PAOI was negatively correlated with left ventricle and left ventricle,and positively correlated with right ventricle,right ventricle,right ventricle to left ventricle ratio and right ventricle to left ventricle ratio.3.RA and RV short diameter,area and volume,RA /LA and RV/LV short diameter ratio,lengthdiameter ratio,area ratio and volume ratio increased with the increase of embolism severity,while LA and LV short diameter,area ratio and volume decreased with the increase of embolism severity(P < 0.05).4.RA/LA volume ratio,RV/LV short diameter,area and volume were0.701,0.728,0.745 and 0.708,respectively,showing high predictive value.RV/LV area ratio≥1.30 had the highest value in predicting early heart failure of acute pulmonary embolism,AUC value 0.745(95%CI: 0.680～0.810,P <0.001),sensitivity 55%,specificity 88.20%.Conclusions: The 256-slice spiral CTPA was used to quantitatively measure the CT metrics of each heart cavity in patients with acute pulmonary embolism.The ratio of right ventricular area to left ventricular area was the most effective parameter for diagnosing right heart failure after acute pulmonary embolism,and the RA/LA volume ratio was another sensitive parameter for evaluating the changes in heart function after APE,which could be used as a potential indicator for identifying early heart failure and risk stratification of acute pulmonary embolism. |
PDF Full Text Request