A comparative study on diagnostic indexes for right ventricular dysfunction in patients with acute pulmonary embolism_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 ZHANG Yanmin , ZHANG Qing , YANG Linying

Department of Respiratory Medicine, The Affiliated Hospitial of Chengde Medical College, Chengde, Hebei 067000, P. R. China;

Corresponding?author：

ZHANG Yanmin, Email: zhyami008@163.com

Keywords：

Pulmonary embolism; Right ventricular dysfunction; Brain natriuretic peptide; Blood pressure; Pulmonary artery systolic pressure

DOI：

10.7507/1671-6205.201806020

Video：

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Objective To explore and compare the diagnostic value of blood pressure, brain natriuretic peptide (BNP), pulmonary artery systolic pressure (PASP) in evaluating right ventricular dysfunction (RVD) in patients with acute pulmonary embolism (APE). Methods A retrospective study was conducted on 84 APE patients who were diagnosed by computed tomographic pulmonary angiography. The patients were divided into a RVD group and a non-RVD group by echocardiography. Eighteen clinical and auxiliary examination variables were used as the research factors and RVD as the related factor. The relationship between these research factors and RVD were evaluated by logistic regression model, the diagnostic value of BNP and PASP to predict RVD was analyzed by receiver-operating characteristic (ROC) curve analysis. Results The patients with RVD had more rapid heart rate, higher diastolic blood pressure, higher mean arterial pressure, higher incidence of BNP>100 pg/ml and higher incidence of PASP>40 mm Hg (allP<0 05="" upon="" logistic="" regression="" model="" bnp="">100 pg/ml (OR=4.904, 95%CI 1.431–16.806, P=0.011) and PASP>40 mm Hg (OR=6.415, 95%CI 1.509–27.261, P=0.012) were independent predictors of RVD. The areas under the ROC curve to predict RVD were 0.823 (95%CI 0.729–0.917) for BNP, and 0.798 (95%CI 0.700–0.896) for PASP. Conclusions Blood pressure related parameters can not serve as a predictor of RVD. Combined monitoring of BNP level and PASP is helpful for accurate prediction of RVD in patients with APE.

Citation： ZHANG Yanmin, ZHANG Qing, YANG Linying. A comparative study on diagnostic indexes for right ventricular dysfunction in patients with acute pulmonary embolism. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(6): 577-581. doi: 10.7507/1671-6205.201806020 Copy

1.	中華醫學會心血管病學分會肺血管病學組. 急性肺血栓栓塞癥診斷與治療中國專家共識 (2015). 中華心血管病雜志, 2016, 44(3): 197-211.
2.	Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J, 2014, 35(43): 3033-3069.
3.	Pieralli F, Olivotto I, Vanni S, et al. Usefulness of bedside testing for brain natriuretic peptide to identify right ventricular dysfunction and outcome in normotensive patients with acute pulmonary embolism. Am J Cardiol, 2006, 97(9): 1386-1390.
4.	楊立恒, 代冰, 劉璠, 等. 急性肺栓塞患者遠期預后隨訪調查及危險因素分析. 中國呼吸與危重監護雜志, 2013, 12(6): 552-557.
5.	Kucher N, Rossi E, De Rose M, et al. Prognostic role of echocardiography among patients with acute pulmonary embolism and a systolic arterial pressure of 90 mm Hg or higher. Arch Intern Med, 2005, 165(15): 1777-1781.
6.	Vanni S, Polidori G, Vergara R, et al. Prognostic value of ECG among patients with acute pulmonary embolism and normal blood pressure. Am J Med, 2009, 122(3): 257-264.
7.	Wong LF, Akram AR, Mcgurk S, et al. Thrombus load and acute right ventricular failure in pulmonary embolism: correlation and demonstration of a " tipping point” on CT pulmonary angiography. Br J Radiol, 2012, 85(1019): 1471-1476.
8.	Araoz PA, Gotway MB, Harrington JR, et al. Pulmonary embolism: prognostic CT findings. Radiology, 2007, 242(3): 889-897.
9.	廖明朗, 石慧芳, 林志東, 等. logistic 回歸模型在 CT 基礎上對于急性肺栓塞右心功能不全的臨床價值. 內科急危重癥雜志, 2016, 22(2): 116-118.
10.	Granér M, Harjola VP, Selander T, et al. N-terminal pro-brain natriuretic peptide, high-sensitivity troponin and pulmonary artery clot score as predictors of right ventricular dysfunction in echocardiography. Heart Lung Circ, 2016, 25(6): 592-599.
11.	Yardan T, Altintop L, Baydin A, et al. B-type natriuretic peptide as an indicator of right ventricular dysfunction in acute pulmonary embolism. Int J Clin Pract, 2008, 62(8): 1177-1182.
12.	Ates H, Ates I, Kundi H, et al. Choice of marker for assessment of RV dysfunction in acute pulmonary embolism: NT-proBNP, pulmonary artery systolic pressure, mean arterial pressure, or blood pressure index. Herz, 2017, 42(8): 758-765.
13.	黃君齡, 陶振鋼, 薛明明, 等. 心超在評估急性肺栓塞患者預后中的價值. 復旦學報 (醫學版), 2015, 42(3): 398-402.
14.	Choi HS, Kim KH, Yoon HJ, et al. Usefulness of cardiac biomarkers in the prediction of right ventricular dysfunction before echocardiography in acute pulmonary embolism. J Cardiology, 2012, 60(6): 508-513.

1. 中華醫學會心血管病學分會肺血管病學組. 急性肺血栓栓塞癥診斷與治療中國專家共識 (2015). 中華心血管病雜志, 2016, 44(3): 197-211.
2. Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J, 2014, 35(43): 3033-3069.
3. Pieralli F, Olivotto I, Vanni S, et al. Usefulness of bedside testing for brain natriuretic peptide to identify right ventricular dysfunction and outcome in normotensive patients with acute pulmonary embolism. Am J Cardiol, 2006, 97(9): 1386-1390.
4. 楊立恒, 代冰, 劉璠, 等. 急性肺栓塞患者遠期預后隨訪調查及危險因素分析. 中國呼吸與危重監護雜志, 2013, 12(6): 552-557.
5. Kucher N, Rossi E, De Rose M, et al. Prognostic role of echocardiography among patients with acute pulmonary embolism and a systolic arterial pressure of 90 mm Hg or higher. Arch Intern Med, 2005, 165(15): 1777-1781.
6. Vanni S, Polidori G, Vergara R, et al. Prognostic value of ECG among patients with acute pulmonary embolism and normal blood pressure. Am J Med, 2009, 122(3): 257-264.
7. Wong LF, Akram AR, Mcgurk S, et al. Thrombus load and acute right ventricular failure in pulmonary embolism: correlation and demonstration of a " tipping point” on CT pulmonary angiography. Br J Radiol, 2012, 85(1019): 1471-1476.
8. Araoz PA, Gotway MB, Harrington JR, et al. Pulmonary embolism: prognostic CT findings. Radiology, 2007, 242(3): 889-897.
9. 廖明朗, 石慧芳, 林志東, 等. logistic 回歸模型在 CT 基礎上對于急性肺栓塞右心功能不全的臨床價值. 內科急危重癥雜志, 2016, 22(2): 116-118.
10. Granér M, Harjola VP, Selander T, et al. N-terminal pro-brain natriuretic peptide, high-sensitivity troponin and pulmonary artery clot score as predictors of right ventricular dysfunction in echocardiography. Heart Lung Circ, 2016, 25(6): 592-599.
11. Yardan T, Altintop L, Baydin A, et al. B-type natriuretic peptide as an indicator of right ventricular dysfunction in acute pulmonary embolism. Int J Clin Pract, 2008, 62(8): 1177-1182.
12. Ates H, Ates I, Kundi H, et al. Choice of marker for assessment of RV dysfunction in acute pulmonary embolism: NT-proBNP, pulmonary artery systolic pressure, mean arterial pressure, or blood pressure index. Herz, 2017, 42(8): 758-765.
13. 黃君齡, 陶振鋼, 薛明明, 等. 心超在評估急性肺栓塞患者預后中的價值. 復旦學報 (醫學版), 2015, 42(3): 398-402.
14. Choi HS, Kim KH, Yoon HJ, et al. Usefulness of cardiac biomarkers in the prediction of right ventricular dysfunction before echocardiography in acute pulmonary embolism. J Cardiology, 2012, 60(6): 508-513.

Chinese Journal of Respiratory and Critical Care Medicine

A comparative study on diagnostic indexes for right ventricular dysfunction in patients with acute pulmonary embolism

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