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Clinical Analysis of Patients with Acute Pulmonary Embolism, Normal Blood Pressure, and Right Ventricular Dysfunction

Author: PengJun
Tutor: CaoJie
School: Tianjin Medical University
Course: Internal Medicine
Keywords: Pulmonary embolism Right ventricuar dysfunction Computed tomography pulmonary angiography Thrombolytic therapy Anticoagulant therapy
CLC: R563.5
Type: Master's thesis
Year: 2013
Downloads: 1
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Abstract

Objective To analysze the clinical features of Patients with Acute Pulmonary Embolism, Normal Blood Pressure, and Right Ventricular Dysfunction to improve the diagnosis and treatment.Methods130hospitalized patients with normotensive APE between January2009and January2012were retrospectively analyzed. The patients underwent transthoracic echocardiography to determine if they were complicated with right ventricular dysfunction (RVD). The clinical features, risk factors, diagnosis, and treatment were analyzed and compared between the normotensive APE patients with or without RVD. Difference was statistically significant variables in the univariate analysis, Enter illegal acts multivariate unconditional logistic regression analysis to establish a logistic regression model.New variable in the SPSS data table containing the individual predicted probability, the New variables and Qanadli embolism index test variables, echocardiographic diagnosis result is the state variable for the ROC curve analysis, to determine the best critical point, sensitivity and specificity, calculated and comparative analysis of the area under the ROC curve.Results1. The difference of patients’age and gender composition in the two groups was not statistically significant (P>0.05);2. There were no statistically significant in the risk factors and diseases between the two groups (P>0.05)3. The incidences of syncope, tachycardia, P2hyperthyroidism, jugular vein filling, and cyanosis were all significantly higher in the RVD group than those in the non-RVD group (P<0.05)4. Computed tomography pulmonary angiography (CTPA) revealed that the incidences of thromboembolism involving the proximal pulmonary artery were also higher in the RVD group(P=0.006, P<0.001), non-RVD group involving the lung segment pulmonary artery were significantly higher than the RVD group (P<0.001)5. Logistic regression model:Y=-2.094+2.472(simple proximal)+2.809 (proximal lobe)-1.623(simple lung segment)+3.252(syncope)+1.041(jugular vein filling)+0.051(increased heart rate)+1.026(P2hyperthyroidism)+0.611(cyanosis).6. The area under the ROC curve of Qanadli embolism index and the logistic regression model, respectively,0.929,0.827, P<0.001. Index Qanadli embolism take the best cutoff point of0.41, specificity of86.5%, a sensitivity of90.2%, a positive likelihood ratio of6.68, negative likelihood ratio of0.11, odds ratio of60.7; logistic regression model to take the most good cutoff point of0.27, specificity of88.8%, a sensitivity of82.9%, positive likelihood ratio was7.40, negative likelihood ratio was0.19, odds ratio of38.9.7. The clinical indicators were all statistically improved after thrombolysis or anticoagulation treatment (P<0.001). But compared with the patients who underwent anticoagulation therapy alone, the cost of treatment and the incidence of minor bleeding were significantly higher, and all the clinical indicators were statistically lower in the patients with thrombolysis plus anticoagulation therapy.Conclusion1. Normal blood pressure with right ventricular dysfunction in patients with acute pulmonary embolism is a common and important subgroup of acute pulmonary embolism. The subgroup of elderly patients with a large proportion of the largest number of incidence between the ages of60to70years, but age is not a pulmonary embolism in patients with right ventricular dysfunction risk factors.2. Thromboembolism involving the proximal pulmonary artery (the main pulmonary artery, left and right pulmonary artery) is an independent risk factor for pulmonary embolism in patients with right ventricular dysfunction, thromboembolism involving the pulmonary artery of the lung segment alone is pulmonary embolism in patients with right ventricular dysfunction independent protective factor.3. Clinical data to establish a logistic regression model [Y=-2.094+2.472(the simple proximal)+2.809(proximal lobe)-1.623(lung segment alone)+3.252(syncope)+1.041(jugular vein filling)+1.026(P2hyperthyroidism)+0.051(increased heart rate)+0.611(cyanosis)], may be a better predictor of pulmonary embolism in patients with right heart dysfunction occurs with high sensitivity and specificity.4. Qanadli embolism Index as well as the evaluation of acute pulmonary embolism in patients with thromboembolic site, the degree of luminal obstruction and thrombosis involving the scope of quantitative analysis of the degree of pulmonary embolism and right ventricular function, with high sensitivity and specificity.5. After14d anticoagulant therapy alone can achieve and thrombolytic therapy equivalent to the therapeutic effect. Thrombolytic therapy is not only expensive, but also a small risk of bleeding increased significantly, thrombolysis and anticoagulation group mortality rates are lower. Therefore, for patients with normal blood pressure associated with RVD APE does not recommend the routine use of thrombolytic therapy, the risk of deterioration and low risk of bleeding in the subgroup of patients can be considered thrombolytic therapy, but how to define this category of the population to be studied further.

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CLC: > Medicine, health > Internal Medicine > Respiratory system and chest diseases > Pulmonary disease > Pulmonary embolism
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