Explore The Value Of The Tricuspid Annulus Plane Systolic Excursion And CT Pulmonary Artery Obstruction Index On The Severity Of Acute Pulmonary Embolism In The Plateau Region

Background The altitude of Tibet Autonomous region is the highest in the world.Hypoxic environment can lead to increased erythropoiesis,hypoxic pulmonary hypertension and cardiac insufficiency.All these factors are high risk factors for thrombosis,so Tibet is a High incidence area of pulmonary embolism.Early diagnosis and evaluation of the severity for their clinical prognosis is essential For patients with acute pulmonary embolism.Objective To explore the value of the Tricuspid annulus plane systolic excursion and CT Qanadli obstruction index on the severity of pulmonary embolism in the plateau region.Methods Thirty-three acute pulmonary embolism patients diagnosed in the pneumology department of the Tibet Autonomous Region People's Hospital between October 2016 and August 2017 were included in this prospective study.All patients were examined by CT pulmonary artery angiography,calculating the Qanadli obstruction index,measure right ventricle/left ventricle short-axis diameter ratio and right atrial/left atrial area ratio.Transthoracic echocardiography was performed Within48 hours after CT examination,measuring the tricuspid annulus plane systolic excursion,right ventricular/left ventricular short-axis diameter ratio and estimated Pulmonary artery systolic pressure.All patients weredivided into two groups according to the sPESI score.All image parameters were examined by the Mann-Whitney U test.The correlation analysis between imaging parameters and sPESI score and the correlation analysis between imaging parameters were made.The diagnostic sensitivity and specificity of imaging parameters were calculated according to the sPESI score.Results 1.In all clinical symptoms,cough and sputum(45%)is more frequent,followed by dyspnea(36%).2.The difference of Cardiac troponin I between high risk group and low risk group was statistically significant(P<0.05).There was no significant difference in D-Dimer and BNP between high risk group and low risk group(P>0.05).3.In the embolic position,The difference of left and right pulmonary embolism between high risk group and low risk group was statistically significant(P<0.05).4.RV / LV and Qanadli obstruction index in CTPA parameters was significantly different between the high risk group and the low risk group(P<0.05).There was no significant difference of RA/LA in CTPA parameters between high risk group and low risk group(P>0.05).5.The difference of RV/LV,PASP and TAPSE in TTE parameters between high risk group and low risk group was statistically significant(P< 0.05).6.The correlation between the imaging parameters and the sPESI score: There was a positive correlation between the RV/LV of CTPA parameters and the sPESI score.It has the same result betwen Qanadli obstruction index and the sPESI score.There was no correlation between the RA/LA of CTPA parameters and the s PESI score.There was a positive correlation between the RV/LV of TTE parameters and the sPESI score.It has the same result betwen PASP of TTE parameters and the s PESI score.The sPESI score was negatively correlated with the TAPSE of TTE parameters.7.Correlation Analysis of Image parameters: There was no significant correlation between Qanadli obstruction index and PASP.There was no significant correlation between Qanadli obstruction index and TAPSE.There was a positive correlation between RV / LV(TTE)and RV / LV(CTPA).There was a negative correlation between RV / LV(TTE)and TAPSE.8.The sensitivity and specificity of RV/LV were better.TAPSE was more sensitive,and the specificity was slightly worse.The specificity of Qanadli obstruction index and PASP is better and the sensitivity is poor.Conclusion 1.CTnI is a sensitive index for evaluating acute pulmonary embolism severity at high altitude.2.Embolism of left and right pulmonary arteries is valuable in evaluating the severity of acute pulmonary embolism at high altitude.3.The measurement of RV/LV ratio in CT and TTE has approximate evaluation value and is a better evaluation index for high altitude APE severity.4.TAPSE has a good evaluation value for the severity of APE at high altitude.5.The Qanadli obstruction index has a certain value for the assessment of Plateau APE severity.6.The evaluation of PASP to plateau APE severity is limited.7.RA/LA has no significant value in evaluating the severity of APE in Plateau8.CTPA combined with RV / LVT ratio(CTPA)can optimize the diagnosis and evaluation procedures for APE patients at high altitude.