Evaluation of right ventricular dysfunction and prediction of clinical outcomes in acute pulmonary embolism by chest computed tomography: comparisons with echocardiography

Abstract

To evaluate the ability to identify right ventricular (RV) dysfunction, and to predict adverse outcomes of chest computed tomography (CT), we compared CT and echocardiography in acute pulmonary embolism patients. We analyzed 56 patients diagnosed by CT with acute pulmonary embolism, who underwent echocardiography within 48 h of CT scan from January 2004 to December 2008. From the CT scan, the ratio of RV diameter to left ventricular diameter (RVd/LVd), the presence of septal bowing and embolus location were determined. RVd/LVd (P < 0.001), septal bowing (P < 0.001) and proximal embolism (P = 0.016) were associated with echocardiographic RV hypokinesia. The odds ratio for adverse clinical outcomes was 19.2 for the combination of three CT parameters (RVd/LVd > 1, septal bowing, and proximal embolism), and 13.4 for RV hypokinesia (each P = 0.001). The positive predictive value (PPV) for adverse clinical outcomes for echocardiographic RV hypokinesia was 55.0%, and the negative predictive value (NPV) was 96.2%. The three-parameter combination predicted adverse clinical outcomes with a PPV of 54.5%, and a NPV of 94.1%. CT parameters including RV dysfunction were significantly associated with poor outcomes. Rapid risk stratification of patients with acute pulmonary embolism based on chest CT appears to be comparable with echocardiography, is clinically reliable, and may be useful in guiding management strategy.

Establishment of a canine model of acute pulmonary embolism with definite right ventricular dysfunction through introduced autologous blood clots

“…Post = post-embolization procedure, MPAP = mean pulmonary artery pressure, PAWP = pulmonary artery wedge pressure, CVP = central venous pressure, CO = cardiac output, PVR = pulmonary vascular resistance, HR = heart rate, MAP = mean arterial pressure. Numerous studies have demonstrated that RV dilation on CT is a sign of RVD and a useful predictor for clinical outcomes in patients with acute PE, including the mortality in-hospital and 30 days and 3 months following discharge [3,4,[26][27][28][29][30][31][32]. In our study, significant RV dilation was observed after embolization, with the RVESV increasing from 11.11 ml to 24.71 ml and the RVEDV from 20.73 ml to 34.63 ml.…”

Computed tomography to assess risk of death in acute pulmonary embolism: a meta-analysis

“…15 studies were initially excluded [10,19,20,22,26,31,33,35,38,39,41,43,46,50,52]. For six of them, the inclusion in the analysis was possible following contact with the authors [22,35,38,39,43,52].…”

The efficacy of CT for detection of right ventricular dysfunction in acute pulmonary embolism, and comparison with cardiac biomarkers

“…It has been shown that correlation of ECHO and CT for detection of RVD is good, despite the different output and measurement methods of the two techniques [9,13,[19][20][21][22][23][24][25]. In a study in which 103 hemodynamically stable PE patients were evaluated for the presence of RVD and pulmonary hypertension (PHT), Golpe et al [9] identified RVD in 24.5 % of cases and PHT in 19.6 %.…”