Correlating computed tomography pulmonary angiography signs of right ventricular strain in pulmonary embolisms to clinical outcomes

Karri, Jay; Truong, Tiffany; Hasapes, Joseph P.; Trujillo, Daniel Ocazionez; Chua, Steven S.; Shiralkar, Kaustubh; Aisenberg, Gabriel M

doi:10.4103/atm.atm_264_19

Cited by 2 publications

(3 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, another study on this topic showed that in most cases, signs of right ventricle strain in CTPA do not reliably predict the severity of PE and subsequent adverse clinical outcomes. Therefore, CTPA should be used with caution in patients with suspected acute PE so the chance of thrombolytic use is not missed due to delays for additional imaging 17 . Moreover, some studies have shown that even in the cases in which PE is excluded, the cardiovascular data from CTPA can be used for diagnosing other pathologies, such as pulmonary hypertension 18 .…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, CTPA should be used with caution in patients with suspected acute PE so the chance of thrombolytic use is not missed due to delays for additional imaging. 17 Moreover, some studies have shown that even in the cases in which PE is excluded, the cardiovascular data from CTPA can be used for diagnosing other pathologies, such as pulmonary hypertension. 18 Nevertheless, there is a need for additional studies CTPA should be individualized to minimize the chance of complications and unnecessary radiation exposure.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Application of CT pulmonary angiography and echocardiography in acute pulmonary embolism: A cross‐sectional study

Sametzadeh,

Dadgostar,

Hanafi

et al. 2023

Health Science Reports

View full text Add to dashboard Cite

BackgroundPulmonary Embolism (PE) is an acute and potentially fatal condition defined as the blockage of pulmonary arteries by an embolism that can be from various origins.ObjectiveThe present study aimed to investigate the findings of computed tomography pulmonary angiography (CTPA) and echocardiography in patients with acute PE.MethodsThe present cross‐sectional study included some patients with clinical manifestations of PE who underwent CTPA and echocardiography. The radiologic findings, PE severity, and outcome of the patients were recorded. Moreover, echocardiography was performed by an expert cardiologist using a high‐resolution device, while CTPA was performed by an expert radiologist using a 16‐slice device and a two‐step selective test bolus method.ResultsAccording to our findings, a total number of 147 patients were diagnosed with PE, including 44 (29.93%), 44 (29.93%), and 59 (40.14%) cases of mild, moderate, and severe PE, respectively. Moreover, 25 patients (17%) finally expired due to PE. Regarding the CTPA findings, 31 patients (21.1%) had septum flattening, while 35 (23.8%) had a septum deviation toward the left ventricle. Also, there were significant correlations between mortality and some CTPA findings, including severe PE (p < 0.001), the presence of septal deviation (p = 0.007), and higher diameters of the main pulmonary artery (p < 0.001) and right ventricle (p = 0.008).ConclusionCTPA is a valid and accessible modality for diagnosing and evaluating PE in suspected patients. Moreover, several findings in CTPA could predict adverse outcomes, such as death, in patients with PE.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Application of CT pulmonary angiography and echocardiography in acute pulmonary embolism: A cross‐sectional study

Sametzadeh,

Dadgostar,

Hanafi

et al. 2023

Health Science Reports

View full text Add to dashboard Cite

show abstract

“…One finding that is strongly correlated with RV dysfunction that is relatively simple to obtain and can be readily assessed by CTPA is RV dilatation. 5,6 Compared with TTE, CTPA has been found to be sensitive for RV dilatation, but less specific. 1 CTPA, however, is often more readily available to outpatient and emergency clinicians than TTE.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Medical Student Measurements of CT Right-to-Left Ventricular Diameter in Patients with Acute Pulmonary Embolism

Durant,

Fetterolf,

Engelhart

et al. 2023

Journal of Medical Education and Curricular Development

View full text Add to dashboard Cite

Objectives: Acute pulmonary embolism (PE) is a common disease, necessitating risk stratification to determine management. A right ventricle (RV) to left ventricle (LV) diameter ratio ≥1.0 on computed tomography pulmonary angiography (CTPA) suggests RV strain, which may indicate a worse prognosis. Two prior studies showed that residents with brief training by a radiologist could accurately measure RV/LV ratio. We assessed whether medical students could accurately measure RV dilatation. Methods: We conducted a post hoc analysis of a retrospective cohort study of adults undergoing management for acute PE at 21 community emergency departments across Kaiser Permanente Northern California from 2013 to 2015. We created a sample, stratified to contain an equal number of patients from each of the 5 PE Severity Index classes. Four medical students measured RV and LV diameter on CTPA after training from an emergency medicine physician and an interventional radiologist. We used Cohen's kappa statistics, Bland-Altman plots, and Pearson correlation coefficients to assess interrater reliability. Results: Of the 108 CTPAs reviewed, 79 (73%) showed RV dilatation and 29 (27%) did not. The kappa statistic for the presence of RV dilatation of the medical students compared to the radiologist showed moderate agreement for 3 medical students (kappa (95% CI): 0.46 (0.21-0.70), 0.49 (0.31-0.68), 0.50 (0.32-0.68)) and fair agreement for 1 medical student (kappa (95% CI): 0.29 (0.10-0.47)). The average interrater differences in RV/LV ratio between a radiologist and each of the 4 medical students were −0.04, −0.05, 0.04, and 0.24. Pearson correlation coefficients were 0.87, 0.80, 0.74, and 0.78, respectively, indicating moderate correlation ( P < .001 for all). Conclusion: Medical students were able to identify RV dilatation on CTPA in moderate agreement with that of a radiologist. Further study is needed to determine whether medical student accuracy could improve with additional training.

show abstract

Correlating computed tomography pulmonary angiography signs of right ventricular strain in pulmonary embolisms to clinical outcomes

Cited by 2 publications

References 19 publications

Application of CT pulmonary angiography and echocardiography in acute pulmonary embolism: A cross‐sectional study

Application of CT pulmonary angiography and echocardiography in acute pulmonary embolism: A cross‐sectional study

Accuracy of Medical Student Measurements of CT Right-to-Left Ventricular Diameter in Patients with Acute Pulmonary Embolism

Contact Info

Product

Resources

About