Left atrial size measured on CT pulmonary angiography: another parameter of pulmonary embolism severity? A systematic review

Zuin, Marco; Rigatelli, Gianluca; Turchetta, Stefano; Zonzin, Pietro; Zuliani, Giovanni

doi:10.1007/s11239-019-01994-8

Cited by 9 publications

(9 citation statements)

References 27 publications

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“…Importantly, no association was found with non–PE-related mortality. These findings are in keeping with the described pathophysiology of decreased LA volume in acute PE, for example, patients with more significant impact from PE with increased pulmonary vascular resistances resulting in increased right-sided pressures and decreased RV output, with relative decreased filling of LA and LA mechanical compression from a dilated RA 19. Our results, obtained in a different tertiary center using different methodology than Aviram and colleagues, are encouraging for the validity of the new paradigm of assessing the LA as a primary predictor of early adverse outcome.…”

Section: Discussionsupporting

confidence: 85%

“…This database was derived by identifying consecutive in-patients with acute PE between May 2007 and December 2014 using the International Classification of Disease (ICD) code 9th edition for acute PE (codes 415.13 and 415. 19) from the medical center electronic medical records. Original database inclusion criteria were: (1) CTPA available in our picture archiving and communication system for review.…”

Section: Methodsmentioning

confidence: 99%

“…There is literature, although limited, on the role of CTPA atrial measurements in risk stratifying patients with acute PE. A systematic review by Zuin et al 19 summarized CT data on the topic. On CTPA, LA diameter, area, and volume have been shown to be negatively correlated with pulmonary artery obstruction index, [20][21][22] and RA/LA diameter ratio is significantly higher in those dying from saddle PE than in survivors at 1 month.…”

Section: Pe-related Mortality and Adverse Eventsmentioning

confidence: 99%

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Evidence for Left Atrial Volume Being an Indicator of Adverse Events in Patients With Acute Pulmonary Embolism

Kirkbride¹,

Heidinger

Filho³

et al. 2021

Journal of Thoracic Imaging

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Purpose: To assess the association between computed tomography pulmonary angiography (CTPA) atrial measurements and both 30-day pulmonary embolism (PE)-related adverse events and mortality, and non–PE-related mortality, and to identify the best predictors of these outcomes by comparing atrial measurements and widely used clinical and imaging variables. Patients and Methods: Retrospective single-center pilot study. Acute PE patients diagnosed on CTPA who also had a transthoracic echocardiogram, electrocardiogram, and troponin T were included. CTPA left atrial (LA) and right atrial (RA) volume and short-axis diameter were measured and compared between outcome groups, along with right ventricular/left ventricular diameter ratio, interventricular septal bowing, tricuspid annular plane systolic excursion, electrocardiogram, and troponin T. Results: A total of 350 patients. LA volume and diameter were associated with PE-related adverse events (P≤0.01). LA volume was the only atrial measurement associated with PE-related mortality (P=0.03), with no atrial measurements associated with non–PE-related mortality. Troponin was most associated with PE-related adverse events and mortality (both area under the curve [AUC]=0.77). On multivariate analysis, combination models did not greatly improve PE-related adverse events prediction compared with troponin alone. For PE-related mortality, the best models were the combination of troponin, age, and either LA volume (AUC=0.86) or diameter (AUC=0.87). Conclusion: Among patients with acute PE, CTPA LA volume is the only imaging parameter associated with PE-related mortality and is the best imaging predictor of this outcome. Reduced CTPA LA volume and diameter, along with increased RA/LA volume and diameter ratios, are significantly associated with 30-day PE-related adverse events, but not with non–PE-related mortality.

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Section: Discussionsupporting

confidence: 85%

Section: Methodsmentioning

confidence: 99%

Section: Pe-related Mortality and Adverse Eventsmentioning

confidence: 99%

See 1 more Smart Citation

Evidence for Left Atrial Volume Being an Indicator of Adverse Events in Patients With Acute Pulmonary Embolism

Kirkbride¹,

Heidinger

Filho³

et al. 2021

Journal of Thoracic Imaging

View full text Add to dashboard Cite

show abstract

“…Several studies validated the use of LA sizes as a prognostic tool in patients with PE [16,[29][30][31]. According to Guo et al, the left-to-right diameter and anterior-posterior diameter of LA showed a positive correlation with the prognosis of PE [31].…”

Section: Left Atrial Sizementioning

confidence: 99%

Acute Pulmonary Embolism: Prognostic Role of Computed Tomography Pulmonary Angiography (CTPA)

et al. 2022

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Computed Tomography Pulmonary Angiography (CTPA) is considered the gold standard diagnostic technique in patients with suspected acute pulmonary embolism in emergency departments. Several studies have been conducted on the predictive value of CTPA on the outcomes of pulmonary embolism (PE). The purpose of this article is to provide an updated review of the literature reporting imaging parameters and quantitative CT scores to predict the severity of PE.

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“…Such lack of consensus translates to difficulty in establishing normative values. In a recent systematic review by Zuin et al [ 8 ] of the potential role of LA size derived by non-ECG-gated CT angiography in patients with acute pulmonary embolism, LA volumes were evaluated in four studies [ 9 , 10 , 11 , 12 ] but none had comparative TTE that could be used for corroboration of the volumes. The results were further limited by the lack of data regarding the presence of atrial fibrillation in the analysed patients.…”

Section: Introductionmentioning

confidence: 99%

Biatrial Volumetric Assessment by Non-ECG-Gated CT Pulmonary Angiography Correlated with Transthoracic Echocardiography in Patients with Normal Diastology

et al. 2022

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Atrial size is a predictor of cardiovascular mortality. Non-ECG-gated computed tomography pulmonary angiography (CTPA) is a common test for cardiopulmonary evaluation but normative values for biatrial volumes are lacking. We derived normal CT biatrial volumes using manual and semiautomated segmentation with contemporaneous transthoracic echocardiography (TTE) to confirm normal diastology. Thirty-five consecutive cases in sinus rhythm with no history of cardio-vascular, renal, or pulmonary disease and normal diastolic function were selected. Planimetric CTPA measurements were compared to TTE volumes measured using area length method. TTE and CTPA derived normal LAVi and RAVi were 27 + 5 and 20 + 6 mL/m2, and 30 + 8 and 29 + 9 mL/m2, respectively. Bland–Altman analysis revealed an underestimation of biatrial volumes by TTE. TTE-CT mean biases for LAV and RAV were −5.7 + 12.0 mL and −16.2 + 14.8 mL, respectively. The CT intraclass correlation coefficients (ICC 95% CI) for LA and RA volumes were 0.99 (0.96–1.00) and 0.96 (0.76–0.99), respectively. There was excellent correlation (p < 0.001) between the semiautomated and manual measurements for LA (r 0.99, 95% CI 0.98–0.99) and RA (r 0.99, 95% CI 0.99–1.00). Atrial volumetric assessment on CTPA is easy and reproducible and can provide additional metric in cardiopulmonary assessment.

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Left atrial size measured on CT pulmonary angiography: another parameter of pulmonary embolism severity? A systematic review

Cited by 9 publications

References 27 publications

Evidence for Left Atrial Volume Being an Indicator of Adverse Events in Patients With Acute Pulmonary Embolism

Evidence for Left Atrial Volume Being an Indicator of Adverse Events in Patients With Acute Pulmonary Embolism

Acute Pulmonary Embolism: Prognostic Role of Computed Tomography Pulmonary Angiography (CTPA)

Biatrial Volumetric Assessment by Non-ECG-Gated CT Pulmonary Angiography Correlated with Transthoracic Echocardiography in Patients with Normal Diastology

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