肺栓塞后慢性血栓栓塞性肺动脉高压与功能损害：FOCUS研究
Chronic thromboembolic pulmonary hypertension and impairment after pulmonary embolism: the FOCUS study.
摘要(中文译文)
为系统评估急性肺栓塞（PE）的远期结局，并探讨符合前瞻性定义标准的肺栓塞后损伤（PPEI）的临床意义，在德国17家高容量中心开展了一项前瞻性多中心观察性队列研究。连续纳入确诊为急性症状性PE的成年患者，采用标准化评估方案，并在3、12和24个月时进行预定访视。共同主要结局为：（i）慢性血栓栓塞性肺动脉高压（CTEPH）的诊断；（ii）PPEI，即随访期间持续性或恶化的临床、功能、生化和影像学参数的综合。共有1017例患者（45%为女性，中位年龄64岁）纳入主要分析。PE诊断后中位随访时间为732天。16例（1.6%）患者诊断为CTEPH，中位诊断时间为129天；估计2年累积发生率为2.3%（1.2-4.4%）。共有880例患者可评估PPEI；2年累积发生率为16.0%（95%置信区间12.8-20.8%）。PPEI有助于识别随访期间诊断为CTEPH的16例患者中的15例（CTEPH与无CTEPH的风险比为393；95%置信区间73-2119）。与无PPEI的患者相比，PPEI患者再住院和死亡风险更高，生活质量更差。在这项前瞻性研究中，CTEPH的2年累积发生率为2.3%，但通过标准化标准诊断的PPEI较为常见。我们的发现支持对急性PE后患者进行系统随访，并可能有助于优化指南推荐和PE后管理算法。
Abstract
To systematically assess late outcomes of acute pulmonary embolism (PE) and to investigate the clinical implications of post-PE impairment (PPEI) fulfilling prospectively defined criteria. A prospective multicentre observational cohort study was conducted in 17 large-volume centres across Germany. Adult consecutive patients with confirmed acute symptomatic PE were followed with a standardized assessment plan and pre-defined visits at 3, 12, and 24 months. The co-primary outcomes were (i) diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH), and (ii) PPEI, a combination of persistent or worsening clinical, functional, biochemical, and imaging parameters during follow-up. A total of 1017 patients (45% women, median age 64 years) were included in the primary analysis. They were followed for a median duration of 732 days after PE diagnosis. The CTEPH was diagnosed in 16 (1.6%) patients, after a median of 129 days; the estimated 2-year cumulative incidence was 2.3% (1.2-4.4%). Overall, 880 patients were evaluable for PPEI; the 2-year cumulative incidence was 16.0% (95% confidence interval 12.8-20.8%). The PPEI helped to identify 15 of the 16 patients diagnosed with CTEPH during follow-up (hazard ratio for CTEPH vs. no CTEPH 393; 95% confidence interval 73-2119). Patients with PPEI had a higher risk of re-hospitalization and death as well as worse quality of life compared with those without PPEI. In this prospective study, the cumulative 2-year incidence of CTEPH was 2.3%, but PPEI diagnosed by standardized criteria was frequent. Our findings support systematic follow-up of patients after acute PE and may help to optimize guideline recommendations and algorithms for post-PE care.
如何引用
AMA
Luca Valerio, Anna C Mavromanoli, Stefano Barco, Christina Abele, Dorothea Becker, Leonhard Bruch, et al. Chronic thromboembolic pulmonary hypertension and impairment after pulmonary embolism: the FOCUS study.. European heart journal. 2022; doi:10.1093/eurheartj/ehac206.
APA
Luca Valerio, Anna C Mavromanoli, Stefano Barco, Christina Abele, Dorothea Becker, Leonhard Bruch, et al (2022). Chronic thromboembolic pulmonary hypertension and impairment after pulmonary embolism: the FOCUS study.. European heart journal. https://doi.org/10.1093/eurheartj/ehac206
GB/T 7714
Luca Valerio, Anna C Mavromanoli, Stefano Barco, Christina Abele, Dorothea Becker, Leonhard Bruch, et al. Chronic thromboembolic pulmonary hypertension and impairment after pulmonary embolism: the FOCUS study.[J]. European heart journal, 2022 doi:10.1093/eurheartj/ehac206.
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