Pulmonary Embolism Outcome: A Prospective Evaluation of CT Pulmonary Angiographic Clot Burden Score and ECG Score

Subramaniam, Rathan M.; Mandrekar, Jay; Chang, Catherine; Blair, D.; Gilbert, Kevin; Peller, Patrick J.; Sleigh, Jamie; Karalus, Noel

doi:10.2214/ajr.07.2858

Cited by 49 publications

(41 citation statements)

References 32 publications

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“…Acute pulmonary embolism (PE) is a common and potentially fatal disease with mortality ranging from 2% to 7%, even when treated with anticoagulation (1). Rapid risk assessment is essential in selecting the appropriate treatment strategy in patients with acute PE because high-risk patients may benefit from thrombolysis or embolectomy in addition to anticoagulation.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of acute pulmonary embolism by sixty-four slice multidetector CT angiography: Correlation between obstruction index, right ventricular dysfunction and clinical presentation

Attia

Seifeldein

Hasan

et al. 2015

The Egyptian Journal of Radiology and Nuclear Medicine

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Introduction: MDCT pulmonary angiography is the method of choice for the detection of pulmonary embolism (PE). The severity of PE as estimated by the obstruction index (OI) and right ventricular dysfunction (RVD) can be evaluated with MDCT. Objective: To investigate the correlation between the OI, RVD and clinical presentation in patients with acute PE. Methods: Among 70 patients with suspected PE, 35 patients proved to have PE with MDCT. The CT OI and the RV/LV diameter (RVD-ratio) using the four-chamber view of the heart were calculated for PE patients. The cut-off for the OI to detect RVD was constructed using ROC curve. Results: Dyspnea and RVD (RVD-ratio >1) were significantly more common in patients with central pulmonary emboli. The mean OI (35% ± 19%) was significantly higher in patients with dyspnea, tachycardia and obesity. A positive correlation was found between the OI and both the CT pulmonary artery diameter (r = 0.66, p < 0.001) and the RVD-ratio (r = 0.628, p < 0.001). The mean OI was significantly higher in patients with RVD (p < 0.001). A CT OI > 43% identified more than 90% of patients with RVD (area under the curve on ROC analysis: 0.825; p < 0.001). Conclusion: The mean OI correlated linearly with PA diameter and RVD-ratio. OI > 43% proved to be an independent predictor of RVD.

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Section: Introductionmentioning

confidence: 99%

Evaluation of acute pulmonary embolism by sixty-four slice multidetector CT angiography: Correlation between obstruction index, right ventricular dysfunction and clinical presentation

Attia

Seifeldein

Hasan

et al. 2015

The Egyptian Journal of Radiology and Nuclear Medicine

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“…[222324] Earlier retrospective studies have identified the clot burden score to be predictive of short-term mortality. Van der Meer reported 11–fold increase risk of dying within 3 months, if the obstruction index was 40% or higher.…”

Section: Discussionmentioning

confidence: 99%

Outcome of pulmonary embolism and clinico-radiological predictors of mortality: Experience from a university hospital in Saudi Arabia

et al. 2014

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OBJECTIVES:The objective of this study is to determine the outcome of pulmonary embolism (PE) and the clinico-radiological predictors of mortality in a university hospital setting.METHODS:A Prospective observational study conducted at King Khalid University Hospital, Riyadh Saudi Arabia between January 2009 and 2012. A total of 105 consecutive patients (49.9 ± 18.7 years) with PE diagnosed by computed tomography pulmonary angiography were followed until death or hospital discharge.RESULTS:Overall in hospital mortality rate was 8.6%, which is lower than other international reports. Two-thirds of patients developed PE during the hospitalization. The most common risk factors were surgery (35.2%), obesity (34.3%) and immobility (30.5%). The localization of the embolus was central in 32.4%, lobar in 19% and distal in 48.6%. A total of 26 patients (25%) had evidence of right ventricular strain and 14 (13.3%) were hypotensive. Multivariate analysis revealed that heart failure (Beta = −0.53, P < 0.001), palpitation (Beta = −0.24, P = 0.014) and high respiratory rate (Beta = −0.211, P < 0.036) were significant predictors of mortality.There was no significant difference in the localization of the embolus or obstruction score between survivors and non-survivors.CONCLUSION:The outcome of PE is improving; however, it remains an important risk factor for mortality in hospitalized patients. Congestive heart failure, tachypnea and tachycardia at presentation were associated with higher mortality. These factors need to be considered for risk stratification and management decisions of PE patients. Radiological quantification of clot burden was not a predictor of death.

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“…[15][16][17] On the other hand, large thrombus burden (as measured by percentage or semi-quantitative indices such as Mastora or Qanadli) does not appear to correlate well with adverse outcomes. [18][19][20] While the criteria for stratification and therefore treatment escalation at present are based upon hemodynamics and RV function, central location of thrombus may be another factor that prompts intervention because thrombus location plays a role in patient selection for catheter-directed therapy and surgical embolectomy.…”

Section: Question 1: Should Submassive Pe Patients Be Treated With Symentioning

confidence: 99%

Four key questions surrounding thrombolytic therapy for submassive pulmonary embolism

2015

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Submassive pulmonary embolism (PE) remains a vexing entity, and the appropriate use of thrombolytic therapy for this subgroup continues to be actively debated. Catheter-directed thrombolysis has shown efficacy for submassive PE and is gaining momentum because of theoretically improved safety. This review poses and responds to four questions that explore the complex issues surrounding optimal therapy of submassive PE.

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Pulmonary Embolism Outcome: A Prospective Evaluation of CT Pulmonary Angiographic Clot Burden Score and ECG Score

Abstract: No statistically significant association was seen between ECG score and CT pulmonary angiographic clot burden at diagnosis and the 12-month all-cause mortality rate of patients diagnosed with pulmonary embolism.

Cited by 49 publications

References 32 publications

Evaluation of acute pulmonary embolism by sixty-four slice multidetector CT angiography: Correlation between obstruction index, right ventricular dysfunction and clinical presentation

Evaluation of acute pulmonary embolism by sixty-four slice multidetector CT angiography: Correlation between obstruction index, right ventricular dysfunction and clinical presentation

Outcome of pulmonary embolism and clinico-radiological predictors of mortality: Experience from a university hospital in Saudi Arabia

Four key questions surrounding thrombolytic therapy for submassive pulmonary embolism

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