The value of CTPA and its Mastora embolization index and D-dimer in the diagnosis of acute pulmonary embolism

【作者】 陈梅桂； 赖清泉； 黄芳； 吴宏； 王毅；

【机构】 福建医科大学附属第二医院；

【摘要】 Objective: To investigate the value of Mastora embolization index and right heart function parameters in the diagnosis of acute pulmonary embolism(APE) in CT pulmonary angiography(CTPA); to determine whether there is a significant correlation between pulmonary embolism index and D-dimer level using the Mastora score; To determine the optimal threshold for the diagnosis of D-dimer levels in APE populations in southern China, and to evaluate the prognosis of APE treatment with Mastoro embolization index, D-dimer and right heart function parameters. Methods: We collected 97 cases(case group) from our hospital from January 2017 to August 2018 due to dyspnea and chest pain, and confirmed APE data in all patients. There were no APE 41 cases(normal control group). The design of APE was evaluated by Mastora et al. The degree method was used to calculate the Mastoro embolization index, with a cut-off point of 21.3%, and the case components were mildly blocked and severely obstructed. 1. Record the patient’s basic clinical characteristics and analyze the risk factors and symptoms of APE. 2. On the CTPA, record right ventricular function parameters, including right ventricular maximum short axis diameter(RVd) and left ventricular maximum short axis diameter(LVd), right ventricle/left ventricular maximum short axis diameter ratio(RVd/LVd), right Atrial maximum short axis diameter(RAd), right ventricular maximum surface area(RVs), left ventricular maximum surface area(LVs), right ventricular/left ventricular maximum surface area ratio(RVs/LVs), main pulmonary trunk maximum diameter(MPA), right pulmonary artery Maximum diameter(RPA) and left pulmonary artery maximum diameter(LPA) were analyzed for differences in right heart function parameters between groups; and inferior vena cava and azygous venous reflux were analyzed in each group. 3. Record the D-dimer level of patients, compare the difference between the case group and the normal control group, and analyze the optimal threshold of D-dimer to diagnose APE in the southern population with the final clinical diagnosis. 4. Forty-nine patients were treated and D-dimer and CTPA were reviewed 3 months later. The Mastoro embolization index, D-dimer and right heart function before and after treatment were compared. Results: 1. In the case group, the most common risk factor for APE is smoking, and malignant tumors are rare; the most common clinical symptoms are dyspnea, and syncope is less common. 2.There were significant differences in RVs, LVs, RVd, LVd, RVd/LVd, RVs/LVs and RAd between the case group and the normal control group, and in the case group, RVs, LVs, RVd, LVd, RVd/LVd, There were also significant differences in RVs/LVs and RAd(P<0.05). The D-dimer value group was larger than the normal control group, and the severe block group was larger than the mild block group(P<0.05). The inferior vena cava reflux in the severely obstructed group was more than that in the normal control group. The severe occlusion group and the mild obstruction group had more venous reflux than the normal control group(P<0.05). Spearman correlation analysis showed that the Mastoro embolization index had the best correlation with RVs/LVs(r=0.658, P<0.001). According to the ROC curve analysis, the maximum AUC was RVd/LVd, which was 0.933(P<0.001). When the RVd/LVd value was 0.99, the diagnosis of APE patients had the best degree of right heart failure, the sensitivity was 80.4%, and the specificity was 100%. 3. The Mastoro embolization index is greater than 21.3% and is associated with high D-dimer levels. 1.4 ug/ml was custom-defined as D-dimer positive, and the clinically confirmed diagnosis was based on the criteria. The specificity of D-dimer for the diagnosis of APE was 68.3%. Spearman correlation analysis showed that D-dimer had the best correlation with RVs/LVs(r=0.458, P<0.001). Based on ROC curve analysis, the optimal threshold for D-dimer level diagnosis of APE in southern China is 1.87 ug/ml. 4.Before and after APE treatment, the differences between Mastora embolization index, D-dimer and some cardiovascular parameters were statistically significant(P<0.05). Conclusions: 1. CTPA provides a very significant Mastoro embolization index and cardiac changes, reflecting the clinical status and risk classification of APE patients, providing an important reference for treatment strategies and patient monitoring. 2. High D-dimer values help to assess the severity of APE, and the optimal threshold for D-dimer diagnosis of APE in southern China may be 1.87 ug/ml. 3. Mastora embolization index, D-dimer level and right heart function parameters are helpful to evaluate the therapeutic effect of APE.更多还原

【Abstract】 Objective: To investigate the value of Mastora embolization index and right heart function parameters in the diagnosis of acute pulmonary embolism(APE) in CT pulmonary angiography(CTPA); to determine whether there is a significant correlation between pulmonary embolism index and D-dimer level using the Mastora score; To determine the optimal threshold for the diagnosis of D-dimer levels in APE populations in southern China, and to evaluate the prognosis of APE treatment with Mastoro embolization index, D-dimer and right heart function parameters. Methods: We collected 97 cases(case group) from our hospital from January 2017 to August 2018 due to dyspnea and chest pain, and confirmed APE data in all patients. There were no APE 41 cases(normal control group). The design of APE was evaluated by Mastora et al. The degree method was used to calculate the Mastoro embolization index, with a cut-off point of 21.3%, and the case components were mildly blocked and severely obstructed. 1. Record the patient’s basic clinical characteristics and analyze the risk factors and symptoms of APE. 2. On the CTPA, record right ventricular function parameters, including right ventricular maximum short axis diameter(RVd) and left ventricular maximum short axis diameter(LVd), right ventricle/left ventricular maximum short axis diameter ratio(RVd/LVd), right Atrial maximum short axis diameter(RAd), right ventricular maximum surface area(RVs), left ventricular maximum surface area(LVs), right ventricular/left ventricular maximum surface area ratio(RVs/LVs), main pulmonary trunk maximum diameter(MPA), right pulmonary artery Maximum diameter(RPA) and left pulmonary artery maximum diameter(LPA) were analyzed for differences in right heart function parameters between groups; and inferior vena cava and azygous venous reflux were analyzed in each group. 3. Record the D-dimer level of patients, compare the difference between the case group and the normal control group, and analyze the optimal threshold of D-dimer to diagnose APE in the southern population with the final clinical diagnosis. 4. Forty-nine patients were treated and D-dimer and CTPA were reviewed 3 months later. The Mastoro embolization index, D-dimer and right heart function before and after treatment were compared. Results: 1. In the case group, the most common risk factor for APE is smoking, and malignant tumors are rare; the most common clinical symptoms are dyspnea, and syncope is less common. 2.There were significant differences in RVs, LVs, RVd, LVd, RVd/LVd, RVs/LVs and RAd between the case group and the normal control group, and in the case group, RVs, LVs, RVd, LVd, RVd/LVd, There were also significant differences in RVs/LVs and RAd(P<0.05). The D-dimer value group was larger than the normal control group, and the severe block group was larger than the mild block group(P<0.05). The inferior vena cava reflux in the severely obstructed group was more than that in the normal control group. The severe occlusion group and the mild obstruction group had more venous reflux than the normal control group(P<0.05). Spearman correlation analysis showed that the Mastoro embolization index had the best correlation with RVs/LVs(r=0.658, P<0.001). According to the ROC curve analysis, the maximum AUC was RVd/LVd, which was 0.933(P<0.001). When the RVd/LVd value was 0.99, the diagnosis of APE patients had the best degree of right heart failure, the sensitivity was 80.4%, and the specificity was 100%. 3. The Mastoro embolization index is greater than 21.3% and is associated with high D-dimer levels. 1.4 ug/ml was custom-defined as D-dimer positive, and the clinically confirmed diagnosis was based on the criteria. The specificity of D-dimer for the diagnosis of APE was 68.3%. Spearman correlation analysis showed that D-dimer had the best correlation with RVs/LVs(r=0.458, P<0.001). Based on ROC curve analysis, the optimal threshold for D-dimer level diagnosis of APE in southern China is 1.87 ug/ml. 4.Before and after APE treatment, the differences between Mastora embolization index, D-dimer and some cardiovascular parameters were statistically significant(P<0.05). Conclusions: 1. CTPA provides a very significant Mastoro embolization index and cardiac changes, reflecting the clinical status and risk classification of APE patients, providing an important reference for treatment strategies and patient monitoring. 2. High D-dimer values help to assess the severity of APE, and the optimal threshold for D-dimer diagnosis of APE in southern China may be 1.87 ug/ml. 3. Mastora embolization index, D-dimer level and right heart function parameters are helpful to evaluate the therapeutic effect of APE.更多还原