Abstract：
OBJECTIVE: To assess the association between computed tomography pulmonary angiography (CTPA) atrial measurements and both 30-day pulmonary embolism (PE)-related adverse events and mortality, and non-PE-related mortality, and to identify the best predictors of these outcomes by comparing atrial measurements and widely used clinical and imaging variables.
METHODS: Retrospective single-center pilot study. Acute PE patients diagnosed on CTPA who also had a transthoracic echocardiogram, electrocardiogram, and troponin T were included. CTPA left atrial (LA) and right atrial (RA) volume and short-axis diameter were measured and compared between outcome groups, along with right ventricular/left ventricular diameter ratio, interventricular septal bowing, tricuspid annular plane systolic excursion, electrocardiogram, and troponin T.
RESULTS: A total of 350 patients. LA volume and diameter were associated with PE-related adverse events (P≤0.01). LA volume was the only atrial measurement associated with PE-related mortality (P=0.03), with no atrial measurements associated with non-PE-related mortality. Troponin was most associated with PE-related adverse events and mortality (both area under the curve [AUC]=0.77). On multivariate analysis, combination models did not greatly improve PE-related adverse events prediction compared with troponin alone. For PE-related mortality, the best models were the combination of troponin, age, and either LA volume (AUC=0.86) or diameter (AUC=0.87).
CONCLUSIONS: Among patients with acute PE, CTPA LA volume is the only imaging parameter associated with PE-related mortality and is the best imaging predictor of this outcome. Reduced CTPA LA volume and diameter, along with increased RA/LA volume and diameter ratios, are significantly associated with 30-day PE-related adverse events, but not with non-PE-related mortality.
METHODS: Retrospective single-center pilot study. Acute PE patients diagnosed on CTPA who also had a transthoracic echocardiogram, electrocardiogram, and troponin T were included. CTPA left atrial (LA) and right atrial (RA) volume and short-axis diameter were measured and compared between outcome groups, along with right ventricular/left ventricular diameter ratio, interventricular septal bowing, tricuspid annular plane systolic excursion, electrocardiogram, and troponin T.
RESULTS: A total of 350 patients. LA volume and diameter were associated with PE-related adverse events (P≤0.01). LA volume was the only atrial measurement associated with PE-related mortality (P=0.03), with no atrial measurements associated with non-PE-related mortality. Troponin was most associated with PE-related adverse events and mortality (both area under the curve [AUC]=0.77). On multivariate analysis, combination models did not greatly improve PE-related adverse events prediction compared with troponin alone. For PE-related mortality, the best models were the combination of troponin, age, and either LA volume (AUC=0.86) or diameter (AUC=0.87).
CONCLUSIONS: Among patients with acute PE, CTPA LA volume is the only imaging parameter associated with PE-related mortality and is the best imaging predictor of this outcome. Reduced CTPA LA volume and diameter, along with increased RA/LA volume and diameter ratios, are significantly associated with 30-day PE-related adverse events, but not with non-PE-related mortality.
摘要：
目的：评估计算机断层扫描肺动脉造影（CTPA）心房测量值与30天肺栓塞（PE）相关不良事件和死亡率之间的关系。和非PE相关的死亡率，并通过比较心房测量值和广泛使用的临床和影像学变量来确定这些结局的最佳预测因子。
方法：回顾性单中心试点研究。CTPA诊断的急性PE患者也有经胸超声心动图，心电图,包括肌钙蛋白T。测量CTPA左心房（LA）和右心房（RA）容积和短轴直径，并在结果组之间进行比较，以及右心室/左心室直径比，室间隔弯曲,三尖瓣环平面收缩期偏移,心电图,和肌钙蛋白T。
结果：共350例患者。LA体积和直径与PE相关不良事件相关(P≤0.01)。LA容积是唯一与PE相关死亡率相关的心房测量值(P=0.03),无心房测量与非PE相关死亡率相关。肌钙蛋白与PE相关不良事件和死亡率最相关（曲线下面积[AUC]=0.77）。在多变量分析中，与单用肌钙蛋白相比,联合模型并未显著改善PE相关不良事件的预测.对于与PE相关的死亡率，最好的模型是肌钙蛋白的组合，年龄,和LA体积(AUC=0.86)或直径(AUC=0.87)。
结论：在急性PE患者中，CTPALA体积是与PE相关死亡率相关的唯一成像参数，并且是该结果的最佳成像预测指标。减少CTPALA体积和直径，随着RA/LA体积和直径比的增加，与30天PE相关的不良事件显着相关，但非PE相关死亡率。
方法：回顾性单中心试点研究。CTPA诊断的急性PE患者也有经胸超声心动图，心电图,包括肌钙蛋白T。测量CTPA左心房（LA）和右心房（RA）容积和短轴直径，并在结果组之间进行比较，以及右心室/左心室直径比，室间隔弯曲,三尖瓣环平面收缩期偏移,心电图,和肌钙蛋白T。
结果：共350例患者。LA体积和直径与PE相关不良事件相关(P≤0.01)。LA容积是唯一与PE相关死亡率相关的心房测量值(P=0.03),无心房测量与非PE相关死亡率相关。肌钙蛋白与PE相关不良事件和死亡率最相关（曲线下面积[AUC]=0.77）。在多变量分析中，与单用肌钙蛋白相比,联合模型并未显著改善PE相关不良事件的预测.对于与PE相关的死亡率，最好的模型是肌钙蛋白的组合，年龄,和LA体积(AUC=0.86)或直径(AUC=0.87)。
结论：在急性PE患者中，CTPALA体积是与PE相关死亡率相关的唯一成像参数，并且是该结果的最佳成像预测指标。减少CTPALA体积和直径，随着RA/LA体积和直径比的增加，与30天PE相关的不良事件显着相关，但非PE相关死亡率。
