BACKGROUND: Risk stratification for patients with acute pulmonary embolism (PE) is important to create applicable treatment and management. Computed tomography pulmonary angiography (CTPA) is the first-line imaging method for assessment of patients PE. The different parameters of this modality can be used as predictors for survival in those patients. AIMS: This study aimed to assess the value of some parameters of CTPA as predictors for short-term mortality in patients with acute PE. PATIENTS AND METHODS: This is a prospective study which included a total of 30 adult patients with acute PE diagnosed with CTPA. Patients’ demographic and clinical data were recorded. Patients were followed up for 30 days after first diagnosis, and the survival rate was recorded. The CTPA parameters including the diameter of pulmonary artery (PA), ascending aorta (AO), superior vena cava (SVC) and inferior cava (IVC), right ventricle/ left ventricle diameter ratio, PA/AO ratio, inferior vena cava reflux as well as bowing of interventricular septum and clot burden according to Qanadli score (QS) were analyzed and compared between survivals and non-survivals. RESULTS: The 30-day survival rate in the present study was 73.33%. None of included demographic factors was significantly associated with the survival rate, while only the presence of abnormal coagulation, as comorbidity, was significantly associated with reduced survival rate. Four CTPA parameters were found to be significantly decreasing the survival rate. These were RV/LV over 1.2 (OR=19.0, 95%CI= 2.54-141.93), followed by IVC reflux (OR= 10.56, 95%CI=1.61-69.12), PA/AO ratio over 1.0 (OR= 12.6, 95%CI= 1.07- 148.13), and QS over 18 (OR=6.33, 95%CI= 1.0 to 40.07). CONCLUSION: CTPA findings that may predict the short term mortality were RV/LV diameter ratio more than 1.2, the high grades of IVC reflux, PA/AO ratio over 1.0 and QS >18. However, most of these parameters are non-specific for PE. |
- Wolberg, A. S. et al. Venous thrombosis. Nat. Rev. Dis. Primers 2015;1: 15006.
- Klok, F. A. et al. Patient outcomes after acute pulmonary embolism. A pooled survival analysis of different adverse events. Am. J. Respir. Crit. Care Med. 2010;181: 501–506.
- Klok, F. A. & Barco, S. Follow‑up after acute pulmonary embolism. Hamostaseologie 2018;38:22–32.
- Konstantinides, S. V. et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur. Heart J 2014; 35:3033–69; 3069a–69k.
- Osman AM, Abdeldayem EH. Value of CT pulmonary angiopathy to predict short-term outcome in patient with pulmonary embolism. Intern J Cardiovascular Imaging 2018:34:975-83.
- El-Menyar A, Nabir S, Ahmed N, et al. Diagnostic implications of computed tomography pulmonary angiography in patients with pulmonary embolism. Ann Thorac Med. 2016;11:269–76.
- Kumamaru KK, Hunsaker AR, Kumamaru H, et al. Correlation between early direct communication of positive CT pulmonary angiography findings and improved clinical outcomes. Chest. 2013;144: 1546e-1554
- Kumamaru KK, George E, Ghosh N, et al. Normal ventricular diameter ratio on CT provides adequate assessment for critical right ventricular strain among patients with acute pulmonary embolism. Int J Cardiovasc Imaging. 2016:1e9.
- Elias A, Mallett S, Daoud-Elias M, et al. Prognostic models in acute pulmonary embolism: a systematic review and meta-analysis. BMJ Open 2016;6:e010324.
- Qanadli SD, El Hajjam M, Vieillard-Baron A, et al. New CT index to quantify arterial obstruction in pulmonary embolism: Comparison with angiographic index and echocardiography. AJR Am J Roentgenol. 2001;176:1415–20.
- Hafeda MM, Elmasry MM. Prediction of short term outcome of pulmonary embolism: parameters at 16 multi-detector CT pulmonary angiography. Egyptian J Radiol Nuclear Med 2014;45:1089-98.
- Bach AG, Taute BM, Baasai N, et al. 30-Day mortality in acute pulmonary embolism: prognostic value of clinical scores and anamnestic features. PLoS One. 2016;11:e0148728.
- Patel A, Kassar K, Veer M, et al. Clot burden serves as an effective predictor of 30 day mortality in patients with acute pulmonary embolism. J Am Coll Cardiol. 2018 Mar, 71 (11 Supplement) A1933
- Friz HP, Molteni M, Sorbo DD, et al. Mortality at 30 and 90 days in elderly patients with pulmonary embolism: a retrospective cohort study. Intern Emerg Med 2015;10:431-436.
- Furlan A, Aghayev A, Chang CC, et al. Short-term mortality in acute pulmonary embolism: clot burden and signs of right heart dysfunction at CT pulmonary angiography. Radiol 2012;265:283–93.
- Al Otair HA, Al-Boukai AA, Ibrahim GF, et al. Outcome of pulmonary embolism and clinico-radiological predictors of mortality: Experience from a university hospital in Saudi Arabia. Ann Thorac Med 2014;9:18-22.
- Collomb D, Paramelle PJ, Calaque O, et al. Severity assessment of acute pulmonary embolism: evaluation using helical CT. Eur Radiol 2003;13:1508–14.
- Ghaye B, Ghuysen A, Willems V, et al. Severe pulmonary embolism: pulmonary artery clot load scores and cardiovascular parameters as predictors of mortality. Radiol 2006; 239:884–891.
- Araoz PA, Gotway MB, Trowbridge RL, et al. Helical CT pulmonary angiography predictors of in-hospital morbidity and mortality in patients with acute pulmonary embolism. J Thorac Imaging 2003;18(4):207–16.
- George E, Kumamaru KK, Ghosh N, et al. Computed tomography and echocardiography in patients with acute pulmonary embolism. Part 2: prognostic value. J Thorac Imaging 2013
- Lim KE, Chan CY, Chu PH, et al. Right ventricular dysfunction secondary to acute massive pulmonary embolism detected by helical computed tomography pulmonary angiography. Clin Imaging 2005;29:16–21.
- Araoz PA, Gotway MB, Harrington JR, et al. Pulmonary embolism: prognostic CT findings. Radiol 2007;242:889–97.
- Moroni A, Bosson JL, Hohn N, et al. Non-severe pulmonary embolism: prognostic CT findings. Eur J Radiol 2011;79:452–58.
- Kang DK,Ramos-Duran L, Schoepf UJ, et al. Reproducibility of CT signs of right ventricular dysfunction in acute pulmonary embolism. AJR Am J Roentgenol 2010;194:1500–6.
- Miller RL, Das S, Anandarangam T. Association between right ventricular function and perfusion abnormalities in hemodynamically stable patients with acute pulmonary embolism. Chest 1998;113:665–70.
- Sen HS, Abakay O, Cetincakmak MG, et al. A single imaging modality in the diagnosis, severity, and prognosis of pulmonary embolism. BioMed Res Intern.
- Çildag MB, Gok M, Karaman CZ. Pulmonary Artery Obstruction Index and Right Ventricular Dysfunction Signs in Initial and Follow up Pulmonary Computed Tomography Angiography in Acute Pulmonary Embolism. J Clin Diagn Res. 2017;11:TC21–TC25.
- Baptista R, Santiago I, Jorge E et al. One-shot diagnostic and prognostic assessment in intermediate to high-risk acute pulmonary embolism patients: the role of multidetector computed tomography. Rev Port Cadiol 2013:32.
- Park CY, Yoo SM, Rho J, et al. The ratio of descending aortic enhancement to main pulmonary artery enhancement measured on pulmonary CT angiography as a finding to predict poor outcome in patients with massive or submassive pulmonary embolism. Tuberc Respir Dis 2012;72:352–59.
- Wu AS, Pezzullo JA, Cronan JJ, et al. CT pulmonary angiography: quantification of pulmonary embolus as a predictor of patient outcome—initial experience. Radiology 2004;230:831–35.
- Engelke C, Rummeny EJ, Marten K. Acute pulmonary embolism on MDCT of the chest: prediction of cor pulmonale and shortterm patient survival from morphologic embolus burden. AJR Am J Roentgenol 2006;186:1265–71.
- Ghuysen A, Ghaye B, Willems V, et al. Computed tomographic pulmonary angiography and prognostic significance in patients with acute pulmonary embolism. Thorax 2005;60:956–61.
- Pech M, Wieners G, Dul P, et al. Computed tomography pulmonary embolism index for the assessment of survival in patients with pulmonary embolism. Eur Radiol 2007;17:1954–59.
- Revel MP, Triki R, Chatellier G, et al. Is It possible to recognize pulmonary infarction on multisection CT images? Radiol 2007;244:875–82.
- Ghanima W, Abdelnoor M, Holmen LO, et al. The association between the proximal extension of the clot and the severity of pulmonary embolism (PE): a proposal for a new radiological score for PE. J Intern Med 2007;261:74–81.
- van der Meer RW, Pattynama PM, van Strijen MJ, et al. Right ventricular dysfunction and pulmonary obstruction index at helical CT: prediction of clinical outcome during 3-month followup in patients with acute pulmonary embolism. Radiology 2005;235: 798–803.
- Aviram G, Rogowski O, Gotler Y, et al. Real-time risk stratification of patients with acute pulmonary embolism by grading the reflux of contrast medium into the inferior vena cava on computerized tomographic pulmonary angiography. J Thromb Haemost 2008;6:1488–1493.
- Oliver TB, Reid JH, Murchison JT. Interventricular septal shift due to massive pulmonary embolism shown by CT pulmonary angiography: an old sign revisited. Thorax 1998;53:1092–94.
|