Ghazaleh Mehdipoor1,2, David Jimenez3,4,5, Laurent Bertoletti6, Jorge Del Toro7, Carmen Fernández-Capitán8, Alessandra Bura-Riviere9, Cristina Amado10, Beatriz Valero11, Ángeles Blanco-Molina12, Remedios Otero13, Egidio Imbalzano14, Ramin Khorasani15, Martin R Prince16,17, Behnood Bikdeli2,18,19, Manuel Monreal20. 1. Department of Medicine, Peconic Bay Medical Center, Northwell Health, Riverhead, NY, USA. 2. Cardiovascular Research Foundation (CRF), New York, NY, USA. 3. Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain. 4. Medicine Department, Universidad de Alcalá, (IRYCIS), Madrid, Spain. 5. CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain. 6. Service de Médecine Vasculaire et Thérapeutique, Hôpital Nord, CHU de Saint-Etienne and INSERM U1059 SAINBIOSE - CIC 1408, Université Jean-Monnet, Saint-Etienne, France. 7. Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 8. Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain. 9. Department of Vascular Medicine, Hôpital de Rangueil, Toulouse, France. 10. Department of Internal Medicine, Hospital Sierrallana, Santander, Spain. 11. Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante, Spain. 12. Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain. 13. Department of Pneumonology, Hospital Universitario Virgen del Rocío, Seville, Spain. 14. Department of Clinical and Experimental Medicine, A.O.U Policlinico "G. Martino", Messina, Italy. 15. Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, USA. 16. Department of Radiology, Weill Cornell Medical College and New York Presbyterian Hospital, New York, USA. 17. Columbia University College of Physicians and Surgeons, New York, NY, USA. 18. Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 19. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA. 20. Department of Internal Medicine, Hospital de Badalona Germans Trias i Pujol, Badalona, Spain. mmonreal.germanstrias@gencat.cat.
Abstract
OBJECTIVES: We explored the variations in use of imaging modalities for confirming pulmonary embolism (PE) according to the trimester of pregnancy. METHODS: We included all pregnant patients with confirmed acute PE from RIETE, a prospective registry of patients with PE (03/2001-02/2020). Imaging modalities included computed tomography pulmonary angiography (CTPA), ventilation-perfusion (V/Q) scan, or presence of signs of acute PE along with imaging-confirmed proximal deep vein thrombosis (pDVT) without pulmonary vascular imaging. We compared the imaging modalities to postpartum patients with PE, and other non-pregnant women with PE. RESULTS: There were 157 pregnant patients (age: 32.7 ± 0.5), 228 postpartum patients (age: 33.9 ± 0.5), and 23,937 non-pregnant non-postpartum women (age: 69.5 ± 0.1). CTPA was the most common modality for confirming PE, from 55.7% in first trimester to 58.3% in second trimester, and 70.0% in third trimester. From first trimester to third trimester, V/Q scanning was used in 21.3%, 16.7%, and 18.3% of cases, respectively. Confirmed pDVT along with the presence of signs/symptoms of PE was the confirmatory modality for PE in 21.3% of patients in first trimester, 19.4% in second trimester, and 6.7% in third trimester. The proportion of postpartum patients confirmed with CTPA (85.5%) was comparable to that of non-pregnant non-postpartum women (83.2%). From the first trimester of pregnancy to postpartum period, there was a linear increase in the proportion of patients with PE diagnosed with CTPA (p = 0.039). CONCLUSION: CTPA was the primary modality for confirming PE in all trimesters of pregnancy, although its proportional use was higher in later stages of pregnancy. KEY POINTS: • Computed tomography pulmonary angiography (CTPA) was the primary modality of diagnosis in all trimesters of pregnancy among patients with confirmed pulmonary embolism, even in the first trimester. • From the first trimester of pregnancy to postpartum period, there was a linear increase in the proportion of patients with pulmonary embolism who were diagnosed based on CTPA. • In the postpartum period, use of CTPA as the modality to confirm pulmonary embolism was comparable to non-pregnant patients.
OBJECTIVES: We explored the variations in use of imaging modalities for confirming pulmonary embolism (PE) according to the trimester of pregnancy. METHODS: We included all pregnant patients with confirmed acute PE from RIETE, a prospective registry of patients with PE (03/2001-02/2020). Imaging modalities included computed tomography pulmonary angiography (CTPA), ventilation-perfusion (V/Q) scan, or presence of signs of acute PE along with imaging-confirmed proximal deep vein thrombosis (pDVT) without pulmonary vascular imaging. We compared the imaging modalities to postpartum patients with PE, and other non-pregnant women with PE. RESULTS: There were 157 pregnant patients (age: 32.7 ± 0.5), 228 postpartum patients (age: 33.9 ± 0.5), and 23,937 non-pregnant non-postpartum women (age: 69.5 ± 0.1). CTPA was the most common modality for confirming PE, from 55.7% in first trimester to 58.3% in second trimester, and 70.0% in third trimester. From first trimester to third trimester, V/Q scanning was used in 21.3%, 16.7%, and 18.3% of cases, respectively. Confirmed pDVT along with the presence of signs/symptoms of PE was the confirmatory modality for PE in 21.3% of patients in first trimester, 19.4% in second trimester, and 6.7% in third trimester. The proportion of postpartum patients confirmed with CTPA (85.5%) was comparable to that of non-pregnant non-postpartum women (83.2%). From the first trimester of pregnancy to postpartum period, there was a linear increase in the proportion of patients with PE diagnosed with CTPA (p = 0.039). CONCLUSION: CTPA was the primary modality for confirming PE in all trimesters of pregnancy, although its proportional use was higher in later stages of pregnancy. KEY POINTS: • Computed tomography pulmonary angiography (CTPA) was the primary modality of diagnosis in all trimesters of pregnancy among patients with confirmed pulmonary embolism, even in the first trimester. • From the first trimester of pregnancy to postpartum period, there was a linear increase in the proportion of patients with pulmonary embolism who were diagnosed based on CTPA. • In the postpartum period, use of CTPA as the modality to confirm pulmonary embolism was comparable to non-pregnant patients.