Evaluation value of CT-based cardiac function parameters combined with biochemical indicators and Wells'score in 30-day poor prognosis of acute pulmonary embolism
Objective To investigate the diagnostic efficacy of 256-slice spiral computer tomography(CT)-based cardiac function parameters,laboratory testing and Wells'scores in the severity of acute pulmonary embolism(APE),and to further observe the value of combined application in predicting 30-day poor prognosis of APE.Methods A total of 225 inpatients diagnosed with APE by CT pulmonary angiography(CTPA)from May 2018 to November 2021 were retrospectively included in the APE group(n=225).They were followed up for 30 days with available complete data.During the same period,participants without APE examined by CTPA were included in the control group(n=70).Clinical data and laboratory indicators(creatine kinase[CK],creatine kinase MB[CK-MB]and D-dimer)were collected and Wells'scores were calculated.The right(RV)and left ventricular(LV)volumes were quantitatively measured by cardiac function software.The right and left ventricular short diameter and cross-sectional area were measured on the transverse view(ax)and reconstructed 4-chamber view(4ch),and their ratios were calculated.The above quantitative indexes were compared between groups.Results There were significant differences in the pulmonary infection,history of coronary heart disease,history of pulmonary embolism or deep vein thrombosis,active stage of cancer,operation/immobilization history and heart rate ≥100 beats/min between the two groups(P＜0.05).There were significant differences in the RVD/LVD-ax,RVA/LVVA-AX,RVD/LVD-4ch,RVA/LVVA-4CH,RVV/LVV,D-dimer and Wells'scores between control group and APE group(P＜0.05).The area under the curve(AUC)of RVD/LDV-AX was the largest in predicting 30-day poor prognosis(AUC=0.692)and early death(AUC=0.724).The AUC of RVA/LVA-ax combined with D-dimer and Wells'score was the largest in predicting early death.Receiver operating characteristic(ROC)curve analysis showed that the risk of increased right cardiac afterload after APE increased when the coronary sinus diameter was greater than 8.65 mm.Conclusion RVA/LVA-ax combined with D-dimer and Wells'score is the optimal predictor of the prognosis of APE.Compared with the reconstruction of 4-chamber cardiac diameter,area and volume,transversal-axis measurement of cardiac morphological changes is superior in evaluating the prognosis of APE.The risk of increased right cardiac afterload after APE increases when the coronary sinus diameter is greater than 8.65mm,which can help clinical risk stratification.
acute pulmonary embolismcardiac function parameterslaboratory indicatorscombined diagnosispoor prognosis
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