The Predictive Value Of GENEVA Score And Color Doppler Echocardiography In Patients With Post-pulmonary Embolism Syndrome

Objective: To explore the predictive value of GENEVA score and some indexes of color Doppler echocardiography in patients with post-pulmonary embolism syndrome(P-PES),so as to construct a new evaluation scale with modified GENEVA score and some indexes of color Doppler echocardiography,as an evaluation tool in clinical diagnosis and treatment,to evaluate the possibility of post-pulmonary embolism syndrome in patients with acute pulmonary thromboembolism,and to prevent and treat it as early as possible.Methods: The patients with acute pulmonary thromboembolism treated in our hospital from November 2015 to June 2018 were retrospectively analyzed.According to the inclusion and exclusion criteria,the patients with complete clinical data were selected as the research objects.According to the occurrence of P-PES 6 months after the diagnosis of acute pulmonary thromboembolism,the patients were divided into P-PES group and non-P-PES group.The clinical characteristics,blood test indexes and some indexes of color Doppler echocardiography of the two groups were collected for statistical analysis.Result: 400 patients with acute pulmonary thromboembolism were included in the study.There was no significant difference in sex and smoking history between P-PES group and non-P-PES group.Patients in P-PES group were more likely to have circulatory diseases and lower extremity deep venous thrombosis,and their sPESI score was higher(P < 0.05).Older age(OR = 1.033,95% CI: 1.007-1.060,95% CI: 1.007-1.060,P < 0.05,P < 0.05),increas of right ventricular anterior and posterior diameter(OR = 2.420,95% CI: 1.071-5.443,P < 0.05),increase of D-dimer(OR = 1.001,95% CI: 1.001-1.001-1.002,P <0.05),increase of pulmonary artery pressure(OR = 1.087,OR = 1.087,95% CI: 1.044-1.044-1.132,P < 0.05),increase of pulmonary artery pressure(OR = 1.087,OR = 1.087,95 885-0.947,P<0.05)are independent risk factors of the occurrence of post-pulmonary embolism syndrome in patients with pulmonary thromboembolism.Both GENEVA score and the simplified version have predictive value for post-pulmonary thromboembolism syndrome(P-PES),they do not have too much difference.But the value is relatively low,the score need further optimization.The including of D-dimer(? 1585ng/mL),lactic acid(? 1.45),partial pressure of oxygen in blood(? 75.1mmHg),high sensitivity troponin(?0.0335ng/mL),NT-ProBNP(? 604.65ng/mL),width of main pulmonary artery(?2.55cm),anterior and posterior diameter of right ventricle(? 2.95cm),and pulmonary artery pressure(? 45.5mmHg)can optimize the evaluation function of the GENEVA(simplified version)scoring model(AUC: 0.896±0.016 VS 0.636±0.027,P < 0.05).In P-PES group,patients who develop pulmonary thromboembolism and pulmonary hypertension(? 46.5mmHg)was more likely to have increased pulmonary pressure after6 months.CONCLUSION: Aging,increase of anterior and posterior diameters of right ventricle,increase of D-dimer,increase of pulmonary artery pressure and decrease of partial pressure of blood oxygen are independent risk factors of post-pulmonary embolism syndrome in pulmonary thromboembolism.GENEVA(simplified version)combined with certain indexes of color Doppler echocardiography(main pulmonary artery width ? 2.55 cm,diameters of anterior and posterior of right ventricle ? 2.95 cm,and pulmonary artery pressure ? 45.5 mHg).The score table has predictive value for P-PES.When the score is higher than 5,PTE patients are more likely to develop P-PES.If the cardiopulmonary pressure is higher than 46.5 mmHg when the patients have pulmonary thromboembolism,they are more likely to get increased pulmonary pressure after 6 months.