Ayşegül GÜRSOY ÇORUH, Aslıhan GÜRÜN KAYA, Akın KAYA, Melahat KUL, Serhat EROL, Ömür AYDIN, Sümeyye AYÖZ, İsmail SAVAŞ

RV/LV oranı ve kardiyak biyobelirteçlerin pulmoner emboliye bağlı mortalite riskini tanımlamada kullanımı

Giriş: Akut pulmoner tromboembolizm (PTE), kardiyovasküler mortalitenin yaygın bir nedenidir. Sağ ventriküler (RV) disfonksiyon en önemli ölüm nedenidir. Bilgisayarlı Tomografi Pulmoner Anjiyografi (BTPA), tanı anında RV işlev bozukluğunun bir göstergesi olan sağ ventrikül genişlemesini tespit edebilir. Bu çalışma, BTPA’da RV işlev bozukluğunu gösteren parametreleri ve erken ölüm bulgularının korelasyonunu belirlemeyi amaçlamaktadır. Materyal ve Metod: Bu retrospektif çalışmada Ocak 2012-Aralık 2017 tarihleri arasında CTPA ile PTE tanısı alan hastaların elektronik dosyaları değerlendirildi. Kalp odaları, IVC reflü ve IVS morfolojisi ölçümleri hesaplandı. Akut PTE tanısı sonrası hastaların hastane içi mortalitesi değerlendirildi. Bulgular: 206 uygun hasta vardı. Değerlendirilen radyolojik parametreler arasında sağ atriyum (RA) boyutu (p= 0,002), PA boyutu (p= 0,003), Ao boyutu (p= 0,006) ve IVC reflü varlığı (p= 0,001) mortalite ile ilişkilendirildi. RV/LV ≥1 ile mortalite arasında anlamlı bir ilişki bulunmadı (p= 0,908). PTE ile ilişkili mortaliteye sahip tüm hastalarda BTPA’da RV/LV oranı ≥1 ve IVC reflü vardı. RV/LV oranı 1 olan hastalar, RV/LV oranı

Using RV/LV ratio and cardiac biomarkers to define the risk of mortality from pulmonary embolism

Introduction: Acute pulmonary thromboembolism (PTE) is a common cause of cardiovascular mortality. Right ventricular (RV) dysfunction is the most important cause of mortality. Computed Tomography Pulmonary Angiography (CTPA) can detect right ventricular enlargement which is an indicator of RV dysfunction at the time of diagnosis. This study aimed to determine the parameters indicating RV dysfunction in CTPA and correlation of early mortality findings. Materials and Methods: In this retrospective study, electronic files of patients diagnosed PTE with CTPA between January 2012 and December 2017 were evaluated. Measurements of heart chambers, IVC reflux, and IVS morphology were calculated. In-hospital mortality of the patients after acute PTE diagnosis was evaluated. Results: There were 206 eligible patients. Among the evaluated radiological parameters, right atrium (RA) size (p= 0.002), PA size (p= 0.003), Ao size (p= 0.006), and the presence of IVC reflux (p= 0.001) were associated with mortality. No significant relationship was found between RV/LV ≥1 and mortality (p= 0.908). All patients with PTE-related mortality had RV/LV ratio ≥1 in CTPA and had IVC reflux. Patients with an RV/LV ratio of ≥1 had statistically significantly higher troponin levels (p= 0.004) and IVC reflux (p= 0.025) compared to patients with an RV/LV ratio of

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1. Barco S, Schmidtmann I, Ageno W, Bauersachs RM, Becattini C, Bernardi E, et al. Early discharge and home treatment of patients with low-risk pulmonary embolism with the oral factor Xa inhibitor rivaroxaban: an international multicentre single-arm clinical trial. Eur Heart J 2020; 41(4): 509-18.
2. Bikdeli B, Lobo JL, Jimenez D, Philip Green P, Fernández- Capitán C, Bura-Riviere A, et al. Early use of echocardiography in patients with acute pulmonary embolism: findings from the RIETE registry. J Am Heart Assoc 2018; 7(17): e009042.
3. Meinel FG, Nance JW Jr., Schoepf UJ, Hoffmann VS, Thierfelder KM, Costello P, et al. Predictive value of computed tomography in acute pulmonary embolism: systematic review and meta-analysis. Am J Med 2015; 128(7): 747-59.e2.
4. Devaraj A, Sayer C, Sheard S, Grubnic S, Nair A, Vlahos I. Diagnosing acute pulmonary embolism with computed tomography: imaging update. J Thorac Imaging 2015; 30(3): 176-92.
5. Turkish Thoracic Society, Pulmonary Thromboembolism Diagnosis And Treatment Comparison Report, 2015.
6. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Respir J 2019; 54(3): 1901647.
7. Barco S, Mahmoudpour SH, Planquette B, Sanchez O, Konstantinides SV, Meyer G. Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: a systematic review and meta-analysis. Barco S, Mahmoudpour SH, Planquette B, Sanchez O, Konstantinides SV, Meyer G. Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: a systematic review and meta-analysis. Eur Heart J 2019; 40(11): 902-10.
8. Konstantinides SV. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014; 35(45): 3145-6.
9. George E, Kumamaru KK, Ghosh N, Gonzalez Quesada C, Wake N, Bedayat A, et al. Computed tomography and echocardiography in patients with acute pulmonary embolism: part 2: prognostic value. J Thorac Imaging 2014; 29(1): W7-12.
10. Becattini C, Agnelli G, Germini F, Vedovati MC. Computed tomography to assess risk of death in acute pulmonary embolism: a meta-analysis. Eur Respir J 2014; 43(6): 1678-90.
11. Baptista R, Santiago I, Jorge E, Teixeira R, Mendes P, Curvo- Semedo L, et al. One-shot diagnostic and prognostic assessment in intermediate- to high-risk acute pulmonary embolism: the role of multidetector computed tomography. Rev Port Cardiol 2013; 32(1): 7-13.
12. Furlan A, Aghayev A, Chang CC, Patil A, Jeon KN, Park B, et al. Short-term mortality in acute pulmonary embolism: clot burden and signs of right heart dysfunction at CT pulmonary angiography. Radiolo 2012; 265(1): 283-93.
13. Ende-Verhaar YM, Kroft LJM, Mos ICM, Huisman MV, Klok FA. Accuracy and reproducibility of CT right-to-left ventricular diameter measurement in patients with acute pulmonary embolism. PloS One 2017; 12(11): e0188862.
14. Heyer CM, Lemburg SP, Knoop H, Holland-Letz T, Nicolas V, Roggenland D. Multidetector-CT angiography in pulmonary embolism-can image parameters predict clinical outcome? Eur Radiol 2011; 21(9): 1928-37.
15. Jimenez D, Lobo JL, Monreal M, Moores L, Oribe M, Barron M, et al. Prognostic significance of multidetector CT in normotensive patients with pulmonary embolism: results of the protect study. Thorax 2014; 69(2): 109-15.
16. Cote B, Jimenez D, Planquette B, Roche A, Marey J, Pastre J, et al. Prognostic value of right ventricular dilatation in patients with low-risk pulmonary embolism. Eur Respir J 2017; 50(6): 1701611.
17. Coutance G, Cauderlier E, Ehtisham J, Hamon M, Hamon M. The prognostic value of markers of right ventricular dysfunction in pulmonary embolism: a meta-analysis. Crit Care 2011; 15(2): R103.
18. Meyer G, Vicaut E, Danays T, Agnelli G, Becattini C, Beyer- Westendorf J, et al. Fibrinolysis for patients with intermediate- risk pulmonary embolism. N Engl J Med 2014; 370(15): 1402-11.
19. Huisman MV, Barco S, Cannegieter SC, Le Gal G, Konstantinides SV, Reitsma PH, et al. Pulmonary embolism. Nat Rev Dis Primers 2018; 4: 18028.
20. Wood KE. Major pulmonary embolism: review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism. Chest 2002; 121(3): 877-905.
21. Rali PM, Criner GJ. Submassive pulmonary embolism. Am J Respir Crit Care Med 2018; 198(5): 588-98.
22. Klok FA, Delcroix M, Bogaard HJ. Chronic thromboembolic pulmonary hypertension from the perspective of patients with pulmonary embolism. J Thromb Haemost 2018; 16(6): 1040-51.
23. Masotti L, Ray P, Righini M, Le Gal G, Antonelli F, Landini G, et al. Pulmonary embolism in the elderly: a review on clinical, instrumental and laboratory presentation. Vasc Health Risk Manag 2008; 4(3): 629-36.
24. Ng AC, Chow V, Yong AS, Chung T, Kritharides L. Prognostic impact of the Charlson comorbidity index on mortality following acute pulmonary embolism. Respiration 2013; 85(5): 408-16.
25. Kohn CG, Mearns ES, Parker MW, Hernandez AV, Coleman CI. Prognostic accuracy of clinical prediction rules for early post-pulmonary embolism all-cause mortality: a bivariate meta-analysis. Chest 2015; 147(4): 1043-62.
26. de Miguel-Diez J, Jimenez-Garcia R, Jimenez D, Monreal M, Guijarro R, Otero R, et al. Trends in hospital admissions for pulmonary embolism in Spain from 2002 to 2011. Eur Respir J 2014; 44(4): 942-50.
27. Ghaye B, Ghuysen A, Willems V, Lambermont B, Gerard P, D’Orio V, et al. Severe pulmonary embolism:pulmonary artery clot load scores and cardiovascular parameters as predictors of mortality. Radiol 2006; 239(3): 884-91.
28. Kumamaru KK, George E, Aghayev A, Saboo SS, Khandelwal A, Rodriguez-Lopez S, et al. Implementation and performance of automated software for computing right-to-left ventricular diameter ratio from computed tomography pulmonary angiography images. J Comput Assist Tomogr 2016; 40(3): 387-92.
29. Bach AG, Nansalmaa B, Kranz J, Taute BM, Wienke A, Schramm D, et al. CT pulmonary angiography findings that predict 30-day mortality in patients with acute pulmonary embolism. Eur J Radiol 2015; 84(2): 332-7.
30. El-Menyar A, Sathian B, Al-Thani H. Elevated serum cardiac troponin and mortality in acute pulmonary embolism: Systematic review and meta-analysis. Respir Med 2019; 157: 26-35.
31. Becattini C, Lignani A, Masotti L, Forte MB, Agnelli G. D-dimer for risk stratification in patients with acute pulmonary embolism. J Thromb Thrombolysis 2012; 33(1): 48-57.
32. Keller K, Beule J, Schulz A, Coldewey M, Dippold W, Balzer JO. D-dimer for risk stratification in haemodynamically stable patients with acute pulmonary embolism. Adv Med Sci 2015; 60(2): 204-10.
33. Maestre A, Trujillo-Santos J, Visona A, Lobo JL, Grau E, Maly R, et al. D-dimer levels and 90-day outcome in patients with acute pulmonary embolism with or without cancer. Thromb Res 2014; 133(3): 384-9.
34. Lee Chuy K, Hakemi EU, Alyousef T, Dang G, Doukky R. The long-term prognostic value of highly sensitive cardiac troponin I in patients with acute pulmonary embolism. Clinical Cardiol 2017; 40(12): 1271-8.
35. Bajaj A, Saleeb M, Rathor P, Sehgal V, Kabak B, Hosur S. Prognostic value of troponins in acute nonmassive pulmonary embolism: a meta-analysis. Heart Lung 2015; 44(4): 327-34.
36. Barco S, Mahmoudpour SH, Planquette B, Sanchez O, Konstantinides SV, Meyer G. Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: a systematic review and meta-analysis. Eur Heart J 2019; 40(11): 902- 10.
37. Staskiewicz G, Czekajska-Chehab E, Uhlig S, Przegalinski J, Maciejewski R, Drop A. Logistic regression model for identification of right ventricular dysfunction in patients with acute pulmonary embolism by means of computed tomography. Eur J Radiol 2013; 82(8): 1236-9.
38. Liu YY, Li XC, Duan Z, Yuan YD. Correlation between the embolism area and pulmonary arterial systolic pressure as an indicator of pulmonary arterial hypertension in patients with acute pulmonary thromboembolism. Eur Rev Med Pharmacol Sci 2014; 18(17): 2551-5.
39. Chow V, Ng AC, Chung T, Thomas L, Kritharides L. Right atrial to left atrial area ratio on early echocardiography predicts long-term survival after acute pulmonary embolism. Cardiovasc Ultrasound 2013; 11: 17.
40. Faghihi Langroudi T, Sheikh M, Naderian M, Sanei Taheri M, Ashraf-Ganjouei A, Khaheshi I. The association between the pulmonary arterial obstruction index and atrial size in patients with acute pulmonary embolism. R Radiol Res Pract 2019; 2019: 6025931.
41. Oz II, Altinsoy B, Serifoglu I, Sayin R, Buyukuysal MC, Erboy F, et al. Evaluation of right atrium-to-right ventricle diameter ratio on computed tomography pulmonary angiography: Prediction of adverse outcome and 30-day mortality. Eur J Radiol 2015; 84(12): 2526-32.
42. Bhave NM, Visovatti SH, Kulick B, Kolias TJ, McLaughlin VV. Right atrial strain is predictive of clinical outcomes and invasive hemodynamic data in group 1 pulmonary arterial hypertension. Int J Cardiovasc Imaging 2017; 33(6): 847- 55.