Computed tomography pulmonary angiography for acute pulmonary embolism: prediction of adverse outcomes and 90-day mortality in a single test

Abstract

Purpose: Pulmonary embolism (PE) is a potentially fatal cardiopulmonary disease; therefore, rapid risk stratification is necessary to make decisions of appropriate management strategies. The aim of this study was to assess various computed tomography (CT) findings in order to find new prognostic factors of adverse outcome and mortality. Material and methods: The study enrolled 104 patients with acute PE. Based on their outcome, patients were categorised into four groups. Comorbidities such as ischaemic heart disease were obtained from their medical records. Patients CT angiography were reviewed for recording variables such as main pulmonary artery diameter and right ventricle (RV)/left ventricle (LV) ratio. Patient deaths up to three months since diagnosis of PE had been registered. Logistic regression analysis was performed to find predictors. Results: Based on multiple logistic regression, RV/LV ratio, LV diameter, and right-sided pulmonary infarction are predictors of mortality in 30 days. An RV/LV ratio of 1.19 could successfully discriminate patients who died within 30 days and those who did not. Conclusions: RV/LV ratio, LV diameter, right-sided pulmonary infarction, assessed with helical CT, can help predict 30-day mortality.

The Accuracy of Various Lung Ultrasonography Findings in Predicting the Necessity for Surfactant Treatment in Neonates With Respiratory Distress Syndrome

“…The role of imaging in assessing various diseases is well-known. [37][38][39][40][41][42][43][44][45] As a result of the important clinical consequences of neonatal respiratory distress and the need to evaluate and diagnose its severity and extent, various diagnostic tools, such as radiographic evaluations, have always been considered. Recently, the use of LUS in assessing the extent of pulmonary involvement has been considered, and specific imaging findings have been identified for this syndrome.…”

Pulmonary infarction in acute pulmonary embolism

“…As the clinical syndrome is based on pleuritic chest pain and hemoptysis, it is thought that these patients present earlier to medical care, and reflect smaller, more peripheral emboli, explaining the lower mortality. When using a CT-based diagnosis, most studies did not find any difference in in-hospital mortality (5,32,68), 30-day (69) and 90-day mortality (68,70) between PE with or without infarction. The 90-day (based on the clinical syndrome) and 12-month (CT-based diagnosis) incidence of recurrent PE recurrence was the same for PE patients with and without pulmonary infarction.…”

Role of CT and MRI in Cardiac Emergencies

“…The role of the Qanadli index in immediate risk stratification is validated but no correlation was observed between the obstruction index and prognosis [ 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ].…”

“…Recently, further studies have focused attention on the additional parameters of RVD; Cozzi et al showed that acute coronary sinus dilatation (>9 mm) increased the risk of all-cause death within 30 days [ 21 ]. Langroudi et al [ 80 ] investigated the association between CTOI and atrial size in patients with acute PE, showing that a higher clot load is associated with a smaller LA size and increased RA/LA ratios [ 80 ]. According to Aviram et al [ 81 ], a decreased volume of LA (<62 mL) is the best predictor of adverse outcome.…”