Keum-Ju Choi1, Seung-Ick Cha2, Kyung-Min Shin3, Jaekwang Lim3, Seung-Soo Yoo1, Jaehee Lee1, Shin-Yup Lee1, Chang-Ho Kim1, Jae-Yong Park1, Won-Kee Lee4. 1. Department of Internal Medicine, Kyungpook National University School of Medicine,Daegu, Korea. 2. Department of Internal Medicine, Kyungpook National University School of Medicine,Daegu, Korea. Electronic address: sicha@knu.ac.kr. 3. Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea. 4. Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
Abstract
INTRODUCTION: Whether right ventricular (RV) dilation on computerized tomography (RVD-CT) is a useful predictor for clinical outcomes of acute pulmonary embolism (PE) remains debatable. Furthermore, data regarding the best combination of prognostic markers for predicting the adverse outcome of PE are limited. MATERIALS AND METHODS: The authors retrospectively reviewed 657 consecutive patients hospitalized at a tertiary referral center with a diagnosis of PE based on multi-detector row CT scan. RESULTS: Patients were allocated into an adverse outcome group (11% [n = 69]) or a low risk group (89% [n = 588]). Multivariate analysis showed that RVD-CT (RV/left ventricle [LV] diameter ratio ≥ 1), high pulmonary embolism severity index (PESI) score (class IV-V), high N-terminal-pro-B-type natriuretic peptide (NT-proBNP,≥ 1,136 pg/ml), and elevated troponin I (≥ 0.05 ng/ml) significantly predicted an adverse outcome (odds ratio [OR] 6.26, 95% confidence interval [CI] 2.74-14.31, p < 0.001; OR 4.71, 95% CI 2.00-11.07, p < 0.001; OR 2.71, 95% CI 1.15-6.39, p = 0.023; and OR 3.00, 95% CI 1.27-7.07, p = 0.012, respectively). The addition of RVD-CT to PESI, NT-proBNP, troponin I or their combinations enhanced the positive predictive values and positive likelihood ratios of an adverse outcome. CONCLUSIONS: RVD-CT could be an independent prognostic factor of adverse outcomes in patients with acute PE, and provides additional prognostic value when combined with other prognostic factors.
INTRODUCTION: Whether right ventricular (RV) dilation on computerized tomography (RVD-CT) is a useful predictor for clinical outcomes of acute pulmonary embolism (PE) remains debatable. Furthermore, data regarding the best combination of prognostic markers for predicting the adverse outcome of PE are limited. MATERIALS AND METHODS: The authors retrospectively reviewed 657 consecutive patients hospitalized at a tertiary referral center with a diagnosis of PE based on multi-detector row CT scan. RESULTS:Patients were allocated into an adverse outcome group (11% [n = 69]) or a low risk group (89% [n = 588]). Multivariate analysis showed that RVD-CT (RV/left ventricle [LV] diameter ratio ≥ 1), high pulmonary embolism severity index (PESI) score (class IV-V), high N-terminal-pro-B-type natriuretic peptide (NT-proBNP,≥ 1,136 pg/ml), and elevated troponin I (≥ 0.05 ng/ml) significantly predicted an adverse outcome (odds ratio [OR] 6.26, 95% confidence interval [CI] 2.74-14.31, p < 0.001; OR 4.71, 95% CI 2.00-11.07, p < 0.001; OR 2.71, 95% CI 1.15-6.39, p = 0.023; and OR 3.00, 95% CI 1.27-7.07, p = 0.012, respectively). The addition of RVD-CT to PESI, NT-proBNP, troponin I or their combinations enhanced the positive predictive values and positive likelihood ratios of an adverse outcome. CONCLUSIONS: RVD-CT could be an independent prognostic factor of adverse outcomes in patients with acute PE, and provides additional prognostic value when combined with other prognostic factors.
Authors: Marzanna Paczyńska; Piotr Sobieraj; Łukasz Burzyński; Maciej Kostrubiec; Małgorzata Wiśniewska; Piotr Bienias; Katarzyna Kurnicka; Barbara Lichodziejewska; Piotr Pruszczyk; Michał Ciurzyński Journal: Arch Med Sci Date: 2016-08-24 Impact factor: 3.318
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