Multidetector computed tomography for acute pulmonary embolism: diagnosis and risk stratification in a single test

Becattini, Cecilia; Agnelli, Giancarlo; Vedovati, Maria Cristina; Pruszczyk, Piotr; Casazza, Franco; Grifoni, Stefano; Salvi, Aldo; Bianchi, Marina; Douma, Renée A.; Konstantinides, Stavros; Lankeit, Mareike; Duranti, Michele

doi:10.1093/eurheartj/ehr108

Cited by 209 publications

(181 citation statements)

References 25 publications

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“…The subcostal four-chamber view was examined for fluid collection within the pericardial sac, right atrium/ventricle (RV) diastolic collapse, left ventricle (LV) impaired function by visual estimation of gross wall contraction and wall thickening, or LV hyperkinesia with impaired filling, RV dilation (RV/LV end diastolic diameter > 0.7) and visual estimation of impaired function [15][16][17]. At least one of other two cardiac views were used in case of doubtful diagnosis, difficult visualization and for confirmation of RV dilation.…”

Section: Ultrasonography Techniquementioning

confidence: 99%

“…At least one of other two cardiac views were used in case of doubtful diagnosis, difficult visualization and for confirmation of RV dilation. The parasternal long axis was examined for pericardial effusion, visual estimation of qualitative LV function, signs of RV dilation (RV/LV end diastolic diameter > 0.7) [17]. The apical four-chamber view was examined for pericardial effusion, qualitative LV function and signs of RV dilation (RV/LV end diastolic diameter > 0.9) [18][19][20].…”

Section: Ultrasonography Techniquementioning

confidence: 99%

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Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department

et al. 2013

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Section: Ultrasonography Techniquementioning

confidence: 99%

Section: Ultrasonography Techniquementioning

confidence: 99%

Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department

et al. 2013

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“…Moreover, most studies only include patients with less severe forms of PE, a fact that is highlighted by the low arterial obstruction and RV/LV indices reported. 5,11,12 Two studies focused only on MDCT findings in massive PE, using different definitions. Ocak et al studied three patients with massive PE and concluded that reduced left atrial and pulmonary vein diameters were important findings on MDCT.…”

Section: Discussionmentioning

confidence: 99%

“…Although there is some evidence that reconstructed four-chamber views may be superior to axial views for the identification of high-risk patients, 19 several studies have found robust prognostic value using standard axial acquisitions to calculate the RV/LV ratio. 11,12,20 In a large retrospective series of 431 patients, 30-day mortality was 15.6% in patients with RV enlargement (reconstructed four-chamber views), defined as RV/LV ratio >0.9 on MDCT, compared to 7.7% in those without this finding. 6 In the above-mentioned meta-analysis of two studies (with two different RV/LV ratio thresholds, 1.5 and 1.0) including 191 normotensive patients with PE, a 58% (95% CI, 51---65%) overall negative and a 57% positive (95% CI, 49---64%) value of RV dilatation were reported on MDCT for predicting early death, yielding a relative risk for in-hospital mortality of 2.28 (95% CI, 0.9---5.9).…”

Section: Discussionmentioning

confidence: 99%

One-shot diagnostic and prognostic assessment in intermediate- to high-risk acute pulmonary embolism: The role of multidetector computed tomography

Baptista

Santiago²,

Jorge

et al. 2013

Revista Portuguesa de Cardiologia

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Introduction: Contrast-enhanced multidetector computed tomography (MDCT) is useful for the diagnosis of pulmonary embolism (PE). However, current guidelines do not support its use for risk assessment in acute PE patients. Objectives: We compared the prognostic impact of MDCT-derived indices regarding mediumterm mortality in a population of intermediate-to high-risk PE patients, mostly treated by thrombolysis. Methods: Thirty-nine consecutive patients admitted to an intensive care unit with acute PE were studied. All patients had a pulmonary MDCT on admission to the emergency room as part of the diagnostic algorithm. We assessed the following MDCT variables: right ventricular/left ventricular diameter (RV/LV) ratio, arterial obstruction index, pulmonary artery-to-aorta diameter ratio and azygos vein diameter. A 33-month follow-up was performed. Results: Mean age was 59.1±19.6 years, with 80% of patients receiving thrombolysis. Followup all-cause mortality was 12.8%. Of the MDCT-derived variables, only the RV/LV ratio had significant predictive value, being higher in patients who suffered the endpoint (1.6±0.5 vs. 1.9±0.4, p=0.046). Patients with an RV/LV ratio ≥1.8 had 11-fold higher medium-term allcause mortality (3.8% vs. 38.8%, p<0.001). Regarding this endpoint, the c-statistic was 0.78 (95% CI, 0.60---0.96) for RV/LV ratio and calibration was good (goodness-of-fit p=0.594). No other radiological index was predictive of mortality. elsevier.pt, day 19/02/2013. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. 8 R. Baptista et al.Although further studies are needed, the simple-to-calculate RV/LV ratio has good discrimination and calibration for predicting poorer outcomes in patients with acute PE. © 2012 Sociedade Portuguesa de Cardiologia Published by Elsevier España, S.L. All rights reserved. Angiografia pulmonar por tomografia computadorizada em doentes com tromboembolia pumonar de médio a alto risco: avaliação diagnóstica e prognóstica num só exame Resumo Introdução: A angiografia pulmonar por tomografia computadorizada com contraste (angio-TC) é recomendada para o diagnóstico mas não para a estratificação de risco em doentes com tromboembolia pulmonar (TEP). Objectivos: Determinar o impacto prognóstico a médio-prazo de vários índices radiológicos obtidos na angio-TC em doentes com TEP de médio a alto risco, a maioria tratados com fibrinólise. Métodos: Estudaram-se 39 doentes admitidos numa unidade de cuidados intensivos por TEP, todos com angio-TC prévia realizada na urgência e seguiram-se durante 33 meses. Mediram-se as seguintes variáveis: razão entre os diâmetros do ventrículo direito e ventrículo esquerdo (índice VD/VE), índice de obstrução arterial, razão ente os diâmetros da artéria pulmonar e aorta e diâmetro da veia ázigos. Resultados: A idade média foi de 59,1 ± 19,6 anos; 80% dos doentes foram tratados com fibrinólise. Durante o período de seguimento clínico, a mortalidade foi 12,8%. Das variáveis analisadas, apenas o índice VD/...

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“…In patients with acute pulmonary embolism, right ventricular dilation can be sought by echocardiography but can also be found by CT performed for diagnostic purposes [26]. Right ventricular dilation, as assessed by either echocardiography (OR 2.4, 95% CI 1.3-4.3) or CT (OR 2.08, 95% CI 1.63-2.66), is associated with an increased risk of death [27,28].…”

Section: Relationship Between Pathophysiology and Risk Of In-hospitalmentioning

confidence: 99%

Anticoagulant treatment for acute pulmonary embolism: a pathophysiology-based clinical approach

Agnelli

Becattini

2015

Eur Respir J

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The management of patients with acute pulmonary embolism is made challenging by its wide spectrum of clinical presentation and outcome, which is mainly related to patient haemodynamic status and right ventricular overload. Mechanical embolic obstruction and neurohumorally mediated pulmonary vasoconstriction are responsible for right ventricular overload. The pathophysiology of acute pulmonary embolism is the basis for risk stratification of patients as being at high, intermediate and low risk of adverse outcomes. This risk stratification has been advocated to tailor clinical management according to the severity of pulmonary embolism.Anticoagulation is the mainstay of the treatment of acute pulmonary embolism. New direct oral anticoagulants, which are easier to use than conventional anticoagulants, have been compared with conventional anticoagulation in five randomised clinical trials including >11 000 patients with pulmonary embolism. Patients at high risk of pulmonary embolism (those with haemodynamic compromise) were excluded from these studies. Direct oral anticoagulants have been shown to be as effective and at least as safe as conventional anticoagulation in patients with pulmonary embolism without haemodynamic compromise, who are the majority of patients with this disease. Whether these agents are appropriate for the acute-phase treatment of patients at intermediate-high risk pulmonary embolism (those with both right ventricle dysfunction and injury) regardless of any risk stratification remains undefined. @ERSpublications New oral anticoagulants are efficacious and safe in haemodynamically stable patients with acute pulmonary embolism http://ow.ly/I2iP5

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Multidetector computed tomography for acute pulmonary embolism: diagnosis and risk stratification in a single test

Abstract: In patients with acute PE, MDCT might be used as a single procedure for diagnosis and risk stratification. Patients without right ventricular dysfunction at MDCT have a low risk of in-hospital adverse outcome.

Cited by 209 publications

References 25 publications

Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department

Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department

One-shot diagnostic and prognostic assessment in intermediate- to high-risk acute pulmonary embolism: The role of multidetector computed tomography

Anticoagulant treatment for acute pulmonary embolism: a pathophysiology-based clinical approach

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