Objective: Main pulmonary artery thromboembolism (MPATE), a subtype of pulmonary thromboembolism (PTE), is characterized by acute onset and high mortality rate. Currently, less is known about the early diagnosis of MPATE. This study aimed to investigate the clinical characteristics and strategies of MPATE, exploring the predictive factors of MPATE.
Methods: Patients with PTE diagnosed by computed tomographic pulmonary angiography (CTPA) were retrospectively included between May 2012 to May 2022 at Sichuan Provincial People's Hospital. Based on imaging characteristics, patients were divided into the MPATE group and Non-MPATE group. The clinical features, treatment strategies, and prognosis were compared between two groups, and high-risk factors in MPATE group were analyzed by multiple logistic regression.
Results: 302 patients with PTE were enrolled, including 142 in MPATE group and 160 in Non-MPATE group. Dyspnea was the most common symptom in both groups, but the proportion of dyspnea was higher in MPATE group (P< 0.05).
Compared with Non-MPATE group, the left ventricular ejection fraction (LVEF), diastolic blood pressure, troponin I (TnI) level, and plasma D-dimer (D-D) level in MPATE group were higher at early admission (P < 0.05). Besides, the MPATE group had a higher proprotion of patients with chronic obstructive pulmonary disease (COPD) and deep vein thrombosis (DVT)(P< 0.05), and the number of patients at moderate-high risk in MPATE group was more than in Non-MPATE group(P< 0.05). The multiple logistic regression analysis showed that COPD (OR= 6.620, 95%CI: 1.825-24.015), dyspnea (OR= 2.300, 95%CI: 1.032-5.124), diastolic blood pressure (OR= 1.031, 95%CI: 1.006-1.057), DVT (OR= 2.330, 95%CI: 1.043-5.209), and LVEF (OR= 1.053, 95%CI: 1.006-1.102) were considered as risk factors of MPATE. In MPATE group, there was a negative correlation between EF and high risk (r= -0.187) or moderate-high risk (r= -0.151), but a positive correlation with low risk (r= 0.181) (P<0.01).
Conclusion: Compared with non-MPATE group, MPATE group were more likely to experience dyspnea, as well as higher levels of diastolic blood pressure and LVEF. Patients with MPATE was also prone to co-occur with comorbidities such as DVT and COPD. These results provided further understanding of MPATE.