心脏计算机断层扫描测量肺栓塞与临床恶化相关
Anthony J Weekes1, Angela M Pikus1, Parker L Hambright1
1Atrium Health's Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina.
人工智能对计算机断层扫描肺血管图 (CTPA) 的分析显示,右心室与左心室的比率 (RV:LV) 为1.5或更高,强烈预测肺栓塞 (PE) 患者的临床恶化. 这一发现通过使用易于获得的成像数据来增强PE风险分层.
科学领域:
- 心脏病学 心脏病学
- 放射学 放射学是一门学科.
- 人工智能在医学中的应用
背景情况:
- 肺栓塞反应小组 (PERT) 通常使用右心室与左心室的比率 (RV:LV) 截止值为1.0从计算机断层扫描肺血管图 (CTPA) 来进行风险分层.
- 来自CTPA的连续测量可以为肺栓塞 (PE) 患者提供更好的风险分层精度.
研究的目的:
- 评估CTPA衍生的心脏测量,特别是RV:LV比率与PE患者急性临床恶化之间的关联.
- 评估CTPA心脏测量和使用先进的PE干预措施之间的相关性.
主要方法:
- 来自八个急诊室的PE注册表的回顾性分析,包括1,639名患者.
- 使用人工智能 (AI) 算法测量匿名CTPA的RV:LV比率.
- 主要结局:住院PE相关的临床恶化 (心脏骤停,需要血管压缩剂的低血压,救援呼吸干预). 二次结果:先进的干预使用. 进行了包括 LASSO 和随机森林在内的多变量分析.
主要成果:
- 人工智能分析了1467个CTPA,与放射科医生相比,在RV:LV分类方面达成88%的协议.
- 经历临床恶化 (11.6%) 或需要先进干预的患者 (19.2%) 与没有出现临床恶化 (11.6%) 的患者相比,平均VR:LV比率 (分别为1.50和1.62) 较高.
- 确定了1.54的最佳RV:LV截止值,与临床恶化概率比率为2.50相关. 由人工智能衍生的RV:LV是随机森林分析恶化的前十大预测因素.
结论:
- 在初始CTPA上,AI衍生的RV:LV测量≥1.5与PE患者的住院临床恶化和高级干预措施密切相关.
- 这些发现突出了利用现有CTPA RV:LV测量的潜力,以加强PE严重性评估和风险分层.
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