Geschlechtsspezifische Unterschiede bei hämodynamisch stabilen Patienten mit akuter Lungenarterienembolie

Zusammenfassung

Hintergrund und Fragestellung: Die Lungenarterienembolie (LE) ist ein kardiovaskulärer Notfall mit hoher Mortalität. Ziel unserer Studie war es, geschlechtsspezifische Unterschiede und Risikofaktoren bei hämodynamisch stabilen Patienten aufzudecken.

Methoden: Die Krankenakten von 129 LE-Patienten (59,7 % weiblich) wurden retrospektiv analysiert und klinische, laborchemische sowie technische Parameter bei Männern und Frauen verglichen. ROC-Kurve und Youden-Index wurden berechnet, um durch kardiales Troponin I (cTnI) eine rechtsventrikuläre Dysfunktion (RVD) und durch D-Dimer ein submassives LE-Stadium vorauszusagen.

Ergebnisse: Frauen mit LE waren älter als die Männer (Median 73,0 [25./75. Perzentile 65,0/81,0] Jahre vs. 65,5 [55,2/76,6] Jahre, p = 0,0095) und hatten häufiger eine submassive LE (82,7 vs. 64,0 %, p = 0,03) mit höherem systolischen pulmonal-arteriellen Druck (38,00  ±  18,23 vs. 27,87  ±  17,32 mmHg, p = 0,0018). Die Multivariablen-Regressionsanalyse bestätigte einen engen Zusammenhang zwischen cTnI und einer RVD (Odds Ratio 2,84; 95 %-Konfidenzintervall [95%CI] 1,52–5,32, p = 0,0011). Die Assoziation zwischen cTnI und RVD war bei Männern (OR 27,67; 95 %CI 3,28–233,31, p = 0,0023) deutlich stärker als bei Frauen (OR 1,52; 95 %CI 0,79–2,93, p = 0,21). Die ROC-Analyse zur Vorhersage einer RVD durch cTnI zeigte für Männer eine größere Fläche unter der Kurve (AUC) (0,92 vs. 0,69). Die AUC zur Vorhersage einer submassiven PE durch den D-Dimerwert war in beiden Geschlechtern ähnlich (0,65 vs. 0,62). Der Grenzwert des cTnI zur Vorhersage einer RVD war bei Frauen und Männern ähnlich (> 0,00 ng/ml vs. > 0,01 ng/ml), während der des D-Dimers zum Erkennen einer submassiven LE bei Männern niedriger war (1,08 mg/dl vs. 1,41 mg/dl).

Folgerung: Normotensive weibliche LE-Patienten sind im Mittel älter und häufiger von einer submassiven LE betroffen. cTnI und RVD sind eng assoziiert. cTnI als Risikostratifikationsmarker ist bei Männern effektiver zur Vorhersage einer RVD als bei Frauen.

Abstract

Background and aim: Pulmonary embolism (PE) is potentially life-threatening. Aim of this study was to identify genderspecific differences in acute PE and in risk stratification of hemodynamically stable PE patients.

Methods: We analysed retrospectively the data of 129 patients with PE (59.7 % women) and compared female and male patients regarding clinical, laboratory and technical parameters. ROC curve and Youden Index were calculated to analyse cardiac troponin I (cTnI) for predicting of right ventricular dysfunction (RVD) and D-Dimer for predicting submassive PE.

Results: 129 patients were included in this study. Female patients were older (median 73.0 [25^th percentile: 65.0/75^th percentile: 81.0] vs. 65.5 [55.2/76.6] years, p = 0.0095) and had more frequent submassive PE (82.7 % vs. 64.0 %, p = 0.03) with higher systolic pulmonary artery pressure (38.00 ± 18.23 vs. 27.87 ± 17.32 mmHg, p = 0.0018). Multivariable regression analysis showed a strong association between cTnI and RVD (OR, 2.84; 95 %CI: 1.52–5.32, p = 0.0011). Association between cTnI and RVD was stronger in male PE patients (OR, 27.67; 95 %CI: 3.28–233.31, p = 0.0023) than in female (OR, 1.52; 95 %CI: 0.79–2.93, p = 0.21). Area under the curve (AUC) for efficiency of cTnI predicting RVD was higher in male patients (0.92 vs. 0.69). AUC for efficiency of D-Dimer predicting submassive PE was similar in both genders (0.65 vs. 0.62). Genderspecific cTnI cut-off values indicating for RVD, were similar in male and female (> 0.00 vs. > 0.01 ng/ml). D-Dimer values above 1.08 mg/dl in male and 1.41 mg/dl in female indicated for submassive PE.

Conclusion: Normotensive female PE patients are in mean older and have more frequently submassive PE stadium. cTnI is associated with RVD. cTnI as risk stratification marker for predicting RVD is more effective in male.

Schlüsselwörter

Troponin - D-Dimer - Risikostratifikation - Lungenarterienembolie - RV-Dysfunktion - Geschlecht

Keywords

troponin - D-dimer - risk stratification - pulmonary embolism - RV dysfunction - gender - sex

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