Abstract
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Objectives: To evaluate the clinical value of ventilation/perfusion single photon emission computed tomography (V/Q SPECT) in patients with pulmonary embolism (PE) and anticoagulant therapy by using V/Q SPECT and indentify factors which may affect the effect of therapy. Material and method: A total of 195 patients who underwent V/Q SPECT in Anzhen Hospital from July 2014 till December 2016 were clinically diagnosed as PE. Sixty-three patients who performed more than twice V/Q SPECT examinations were recruited in our current study. According to extent of lung perfusion defect (PD) involved lung volume (%), the severity of PE was defined as mild (<20%), moderate (20-50%), and severe (>50%). Further, according to the changes of PD at follow-up, patients were considered to be treated effectively, if the extent of lung PD decreased≥50% or no new PD was detected. Further, according to the mean pulmonary artery pressure (mPAP) measured by echocardiography, patients were defined as normal (<25mmHg), mild pulmonary hypertension (PAH) (25-49mmHg), moderate (50-70mmHg) and severe PAH (mPAP <70mmHg). Results: A total of 476 pulmonary segments and sub-segments PD were detected. The location of PD had no statistically significant difference within different lung lobes (p>0.05). The prevalence of PAH was higher in patients with severe (80.0%, 12/15) and moderate PE (66.7%, 16/24) than that in patients with mild PE (41.7%, 10/24) (p<0.05). Patients with CAD were more likely to be mild PE in comparison with patients without CAD (67% vs. 33%, χ2=5.281, p=0.07). More PAH were detected in patients with severe PE (n=12, 80.0%) and moderate PE (n=16, 66.7%), in comparison with patients with mild PE (n=10, 41.7%, χ2=6.320, p=0.04). Among those 3 groups, age and relevant serum markers including TNI/BNP/GLU/TG/CRP/G-Hb did not differ (p>0.05). (2) After 8.0±4.6 months V/Q SPECT scan were followed-up, 25 patients (40%) was treated effectively and 38 patients (60%) did not. 49% of patients with normal or mild PAH (n=45) were treated effectively, while only 17% with moderate and severe PAH (n=18) were treated effectively (χ2=5.577, p<0.05). Conclusion: V/Q SPECT has important clinical value for evaluating the effects of anticoagulant therapy and guiding individual therapy. The more extent of PD involved, the higher prevalence of PAH, and PE patients with moderate or severe PAH could not be treated effectively, it may indicate worse prognosis.