Min Liu1, Ran Miao2, Xiaojuan Guo3, Li Zhu4, Hongxia Zhang5, Qing Hou6, Youmin Guo7, Yuanhua Yang8. 1. Department of Radiology, Beijing Chaoyang Hospital of Capital Medical University, Beijing 100020, China. Electronic address: drradiology@163.com. 2. Clinical Laboratory, Beijing Chaoyang Hospital of Captial Medical Univerisity, Beijing, 100020, China. 3. Department of Radiology, Beijing Chaoyang Hospital of Capital Medical University, Beijing 100020, China. 4. Li Zhu, Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan 750004, China. 5. Department of Radiology, China Rehabilitation Research Center of Capital Medical University, Beijing 100068, China. 6. Department of Radiology, Beijing Pu Ren Hospital, Beijing 100062, China. 7. Department of Radiology First Affiliated Hospital of Medical College of Xi'an JiaoTong University, Xi'an Shannxi, 710061, China. 8. Respiratory Diseases Research Center, Beijing Chaoyang Hospital of Capital Medical University, Beijing 100020, China.
Abstract
BACKGROUND: Saddle pulmonary embolism (SPE) is rare type of acute pulmonary embolism and there is debate about its treatment and prognosis. Our aim is to assess laboratory and computed tomographic pulmonary angiographic (CTPA) findings to predict short-term mortality in patients with SPE. METHODS: This was a five-centre, retrospective study. The clinical information, laboratory and CTPA findings of 88 consecutive patients with SPE were collected. One-month mortality after diagnosis of SPE was the primary end-point. The correlation of laboratory and CTPA findings with one-month mortality was analysed with area under curve (AUC) of receiver operating characteristic (ROC) curves and logistic regression analysis. RESULTS: Eighteen patients with SPE died within one month. Receiver operating characteristic curves revealed that the cutoff values for the right and left atrial diameter ratio, the right ventricular area and left ventricular area ratio (RVa/LVa ratio), Mastora score, septal angle, N-terminal pro-brain natriuretic peptide and cardiac troponin I (cTnI) for detecting early mortality were 2.15, 2.13, 69%, 57°, 3036 pg/mL and 0.18ng/mL, respectively. Using logistic regression analysis of laboratory and CTPA findings with regard to one-month mortality of SPE, RVa/LVa ratio and cTnI were shown to be independently associated with early death. A combination of cTnI and RVa/LVa ratio revealed an increase in the AUC value, but the difference did not reach significance compared with RVa/LVa or cTnI, alone (P>0.05). CONCLUSION: In patients with SPE, both the RVa/LVa ratio on CTPA and cTnI appear valuable for the prediction of short-term mortality.
BACKGROUND: Saddle pulmonary embolism (SPE) is rare type of acute pulmonary embolism and there is debate about its treatment and prognosis. Our aim is to assess laboratory and computed tomographic pulmonary angiographic (CTPA) findings to predict short-term mortality in patients with SPE. METHODS: This was a five-centre, retrospective study. The clinical information, laboratory and CTPA findings of 88 consecutive patients with SPE were collected. One-month mortality after diagnosis of SPE was the primary end-point. The correlation of laboratory and CTPA findings with one-month mortality was analysed with area under curve (AUC) of receiver operating characteristic (ROC) curves and logistic regression analysis. RESULTS: Eighteen patients with SPE died within one month. Receiver operating characteristic curves revealed that the cutoff values for the right and left atrial diameter ratio, the right ventricular area and left ventricular area ratio (RVa/LVa ratio), Mastora score, septal angle, N-terminal pro-brain natriuretic peptide and cardiac troponin I (cTnI) for detecting early mortality were 2.15, 2.13, 69%, 57°, 3036 pg/mL and 0.18ng/mL, respectively. Using logistic regression analysis of laboratory and CTPA findings with regard to one-month mortality of SPE, RVa/LVa ratio and cTnI were shown to be independently associated with early death. A combination of cTnI and RVa/LVa ratio revealed an increase in the AUC value, but the difference did not reach significance compared with RVa/LVa or cTnI, alone (P>0.05). CONCLUSION: In patients with SPE, both the RVa/LVa ratio on CTPA and cTnI appear valuable for the prediction of short-term mortality.