心力衰竭合并急性肺栓塞时血栓负荷与临床表现的相关性

doi:10.3969/j.issn.1002-1949.2018.10.002

Chinese Journal of Critical Care Medicine

2018, Vol. 38

Issue (10): 837-841 DOI: 10.3969/j.issn.1002-1949.2018.10.002

Correlation between clot burden and clinical presentations in patients with acute pulmonary embolism and heart failure

Wang Dan-dan, Mi Yu-hong, Ma Xiao-hai, Zhao Lei

Intensive Care Unit of Emergency Department, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China

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Abstract Objective The purpose of our study is to assess the correlation between clot burden and clinical presentations in the submassive pulmonary embolism (PE) patients with preexisting heart failure. Methods All eligible patients were the first episode of submassive acute PE, and were classified as two groups based on with or without preexisting heart failure. Clinical presentations of the patients were collected on admission. Obstruction score and RV/LV ratio was calculated by two experienced of medical imaging practitioner on CT scan. Results A total of 152 submassive PE patients were included in the final population. Thirty-five (23%) patients with previous cardiac inefficiency (group Ⅰ) and 117 (77%) patients without (group Ⅱ) were enrolled. There were significant differences on the baseline condition, patients in group Ⅰ have higher proportion of hypertension (P=0.031), dyslipidemia (P=0.034), coronary arteriosclerotic heart disease (P=0.045), chronic kidney disease (P=0.024), and pulmonary hypertension (P=0.025) than those in the groupⅡ. No significant correlation was found for CT obstruction score (OS) in the two groups (29.4 in group Ⅰ vs. 32.4 in group Ⅱ, P=0.083). There were no significant differences in HR and RR between the two groups. Patients in group Ⅰ showed much lowered LVEF than that in group Ⅱ (35.4 vs. 65.0, P<0.000). Patients in group Ⅰ showed lower oxygenation index, RV/LV and MBP than those in group Ⅱ(285.9 vs. 328.5, P<0.000), (0.91 vs. 1.39, P<0.000) and (62.2 mm Hg vs. 65.8 mm Hg, P=0.002) respectively. In group Ⅰ, OS didn′t showed a direct correlation for RV/LV in group Ⅰ(r=0.086, P=0.962). No significant correlation was also found for OS and HR (r=0.010, P=0.542), and OS and RR (r=0.132, P=0.192). OS showed a strong inverse correlation for oxygenation index (r=-0.637, P=0.025) and a strong inverse correlation for MBP (r=-0.610, P=0.036). In groupⅡ, OS showed a strong correlation for RV/LV(r=0.624, P=0.000), and a moderate inverse correlation both for oxygenation index (r=-0.473, P=0.032) and MBP (r=-0.570, P=0.036). On the other hand, correlations of OS with HR (r=0.266, P=0.025) and OS with RR (r=0.321, P=0.028) were weaker. Conclusion Patients show different clinical characteristics under the same OS condition due to different degree of cardiac function status. Different from most of the PE patients, patients with preexisting heart failure haven′t shown obviously signs of tachycardia and tachypnea. RVD, as a marker for the severity of pulmonary obstruction, couldn′t reflect the severity of pulmonary obstruction for the submassive PE patients with preexisting heart failure.

Key words： Acute pulmonary embolism Heart failure Pulmonary artery obstruction score Right ventricular dysfunction Clinical presentations

Corresponding Authors: Mi Yu-hong, E-mail: myhicu@163.com

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Cite this article:

Wang Dan-dan,Mi Yu-hong,Ma Xiao-hai, et al. Correlation between clot burden and clinical presentations in patients with acute pulmonary embolism and heart failure[J]. Chinese Journal of Critical Care Medicine, 2018, 38(10): 837-841.

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http://www.cnemergency.org.cn/EN/10.3969/j.issn.1002-1949.2018.10.002 OR http://www.cnemergency.org.cn/EN/Y2018/V38/I10/837

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