Mads Dam Lyhne1,2, Jacob Gammelgaard Schultz1,2, Peter J MacMahon3, Faris Haddad4, Mannudeep Kalra5, David Mai-King Tso5, Alona Muzikansky6, Michael H Lev5, Christopher Kabrhel7. 1. Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. 2. Department of Cardiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, Aarhus N, 8200, Aarhus, Denmark. 3. Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Dublin, Ireland. 4. Department of Radiology, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA, 22042, USA. 5. Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. 6. Biostatistics Center, Massachusetts General Hospital, 50 Staniford Street, Boston, MA, 02114, USA. 7. Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. ckabrhel@partners.org.
Abstract
PURPOSE: Patients with acute pulmonary embolism (PE) can quickly deteriorate and the condition has high mortality due to right ventricular (RV) failure. Immediately available predictors of adverse outcome are of major interest to the treating physician in the acute setting. The purpose of the present study was to evaluate if easily attainable measurements of RV function from the diagnostic computed tomography pulmonary angiography (CTPA) provide information for fast risk stratification in patients with acute PE. METHODS: We retrospectively evaluated images from CTPA in 261 patients (age median 60 years, 50% females) enrolled in a prospective study. RV and left ventricular (LV) diameters and their ratio, the presence of septal bowing, contrast reflux in the inferior vena cava, and the diameter of the central pulmonary arteries (PA) were measured. The composite outcome was 5-day severe adverse events including death, acute decompensation, or need for emergent treatment. We used Wilcoxon rank sum test and Fischer's exact test to test between groups and multivariate logistic regression for prediction. RESULTS: In multivariate analysis, increased diameter of the main PA (OR = 1.08 per 1 mm increase, p = 0.047) and the presence of septal bowing (OR = 2.23, p = 0.055) were associated with severe adverse events. RV/LV > 1 did not predict severe outcomes (OR = 0.73, p = 0.541). CONCLUSIONS: Two easily attainable parameters of RV function on CTPA, septal bowing and main PA diameter, are associated with short-term adverse outcomes in patients with acute PE. Further study is required to determine whether these findings can be incorporated into clinical treatment algorithms.
PURPOSE:Patients with acute pulmonary embolism (PE) can quickly deteriorate and the condition has high mortality due to right ventricular (RV) failure. Immediately available predictors of adverse outcome are of major interest to the treating physician in the acute setting. The purpose of the present study was to evaluate if easily attainable measurements of RV function from the diagnostic computed tomography pulmonary angiography (CTPA) provide information for fast risk stratification in patients with acute PE. METHODS: We retrospectively evaluated images from CTPA in 261 patients (age median 60 years, 50% females) enrolled in a prospective study. RV and left ventricular (LV) diameters and their ratio, the presence of septal bowing, contrast reflux in the inferior vena cava, and the diameter of the central pulmonary arteries (PA) were measured. The composite outcome was 5-day severe adverse events including death, acute decompensation, or need for emergent treatment. We used Wilcoxon rank sum test and Fischer's exact test to test between groups and multivariate logistic regression for prediction. RESULTS: In multivariate analysis, increased diameter of the main PA (OR = 1.08 per 1 mm increase, p = 0.047) and the presence of septal bowing (OR = 2.23, p = 0.055) were associated with severe adverse events. RV/LV > 1 did not predict severe outcomes (OR = 0.73, p = 0.541). CONCLUSIONS: Two easily attainable parameters of RV function on CTPA, septal bowing and main PA diameter, are associated with short-term adverse outcomes in patients with acute PE. Further study is required to determine whether these findings can be incorporated into clinical treatment algorithms.
Entities:
Keywords:
Acute pulmonary embolism; Computed tomography; Emergency care; Predictors; Right ventricular function
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