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在急性肺栓塞中右心血栓:在中国的一个单一中心的经验
Wen Li1, Zhi-Ying Liu1, Xiao-Xi Chen1
1State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
Pulmonary circulation
|September 25, 2023
概括
在急性肺栓塞 (APE) 中的右心血栓 (RHT) 是罕见但致命的. 逆转激素显著增加死亡风险,特别是在心脏功能不佳的年轻男性中. 在高风险的APE患者中,早期检测至关重要.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 血管医学 血管医学
背景情况:
- 右心血栓 (RHT) 是急性肺栓塞 (APE) 的罕见但危及生命的并发症.
- 在APE中缺乏对RHT的明确管理准则.
- 了解RHT的临床特征和结果对于改善患者护理至关重要.
研究的目的:
- 在中国人群中APE的背景下,研究RHT患者的临床特征和结果.
- 确定与APE患者中RHT存在相关的风险因素.
- 评估RHT对APE短期和长期死亡率的影响.
主要方法:
- 在2015年9月至2019年8月期间诊断的17名RHT-APE患者和329名非RHT-APE患者的回顾性研究.
- 随访时间中位数为360天.
- 使用多变量逻辑回归和卡普兰-梅尔分析来评估风险因素和生存结果.
主要成果:
- 在APE中,RHT的总体患病率为4.91%,随着APE风险分层的增加而增加.
- RHT-APE患者年轻,男性更频繁,血液动力学不稳定性更差,心脏功能更差,风险分层更高.
- 对RHT的独立风险因素包括高/中高风险分层,右心室 (RV) 运动减少,NT-proBNP>600 pg/mL和RV功能障碍.
- 在APE中,RHT是30天死亡率的独立风险因素,与非RHT患者相比,预后明显更差 (30天和90天的存活率).
结论:
- 右心血栓是急性肺栓塞死亡的独立风险因素.
- 年轻男性患者的RV运动减少,NT-proBNP升高,RV功能障碍或高风险分层要求对RHT进行密切评估.
- RHT的存在会使结果恶化,特别是在患有APE高早期死亡风险的患者中.
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