Septal bowing and pulmonary artery diameter on computed tomography pulmonary angiography are associated with short-term outcomes in patients with acute pulmonary embolism

Lyhne, Mads Dam; Schultz, Jacob Gammelgaard; MacMahon, Peter; Haddad, Faris; Kalra, Mannudeep K.; Tso, David; Muzikansky, Alona; Lev, Michael H.; Kabrhel, Christopher

doi:10.1007/s10140-019-01709-9

Cited by 28 publications

(21 citation statements)

References 38 publications

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“…Meinel et al reported RV/LV diameter ratio as the strongest predictor of the clinical outcome of PTE [23]. However, we did not find any association between RV/LV ratio and PESI, which is in accordance with the report of Lyhne et al [14]. The different results in different studies indicate that further studies are needed on this subject.…”

Section: Discussionsupporting

confidence: 90%

“…In addition to studies reflecting the presence of backwash contrast as a sign of RV dysfunction, some published articles have suggested this sign as an unreliable predictor [14,15]. In this study, an abnormal septal morphology was significantly more common among patients with a highrisk PE.…”

Section: Discussionmentioning

confidence: 47%

“…It suggests the idea that pulmonary trunk size can be used as a factor in prediction of patients with high-risk PE. The association between pulmonary artery diameter and short-term clinical outcomes was observed in a report of Lyhne et al However, they did not report the pulmonary artery diameter as a strong predictor of PE outcomes [14].…”

Section: Discussionmentioning

confidence: 93%

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The assessment of acute pulmonary embolism severity using CT angiography features

et al. 2020

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Background: This study was conducted to detect the association between radiologic features of CT pulmonary angiography (CTPA) and pulmonary embolism severity index (PESI). Methods: A total of 150 patients with a definite diagnosis of PE entered the study. The CTPA feature including obstruction index, pulmonary trunk size, presence of backwash contrast, septal morphology, right ventricular (RV) and left ventricular (LV) dimensions, and RV/LV ratio were examined. The severity of the PE was estimated using PESI. The association between CTPA indices and PESI was measured. Statistical analysis was conducted using the SPSS software. P value < 0.05 was considered as statistically significant. Results: A positive correlation was detected between the obstruction index and PESI (r = 0.45, P < 0.05). Moreover, PESI was significantly higher in patients with a more dilated pulmonary trunk (r = 0.20, P < 0.05). The backwash contrast and abnormal septal morphology were significantly more common among patients with higher PESI (P < 0.05). However, no significant correlation was detected between RV, LV, RV/LV, and PESI. The most predictor of high-risk PE was dilated pulmonary trunk with an odds ratio of 4.4. Conclusion: Higher Obstruction index, dilated pulmonary trunk, presence of backwash contrast, and an abnormal septal morphology can be associated with a higher PESI.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 47%

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The assessment of acute pulmonary embolism severity using CT angiography features

et al. 2020

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“…Our study showed that the maximum MPA diameter (31.5 ± 4.1) in the adverse outcome group was significantly meaningful, a finding similar to the study performed by Ilker et al [29] (31.3, 95% CI: 24.3-46.4) in patients who experienced adverse outcomes; however, their findings did not reach significance (p = 0.209). In another study done by Lyhne et al [7], increased diameter of the MPA (OR = 1.08 per 1 mm increase, p = 0.047) was associated with severe adverse outcome. Collomb et al [16] found that patients with severe pulmonary embolism have larger central pulmonary artery diameters than those in other patients; we had similar findings.…”

Section: Main Pulmonary Artery Diameter (Mm)mentioning

confidence: 85%

“…Patients with PE may have different outcomes and therefore require varying intensities of clinical care. Consequently, risk assessment is necessary to make proper management strategy decisions [5][6][7]. Patients at high risk of adverse outcomes must be admitted to intensive care units and undergo thrombolytic treatment, whereas hospital discharge or home treatment might be options for patients with a low probability of adverse outcomes [8,9].…”

Section: Introductionmentioning

confidence: 99%

Computed tomography pulmonary angiography for acute pulmonary embolism: prediction of adverse outcomes and 90-day mortality in a single test

Akhoundi¹,

Langroudi²,

Rajebi

et al. 2019

Pol J Radiol

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Purpose: Pulmonary embolism (PE) is a potentially fatal cardiopulmonary disease; therefore, rapid risk stratification is necessary to make decisions of appropriate management strategies. The aim of this study was to assess various computed tomography (CT) findings in order to find new prognostic factors of adverse outcome and mortality. Material and methods: The study enrolled 104 patients with acute PE. Based on their outcome, patients were categorised into four groups. Comorbidities such as ischaemic heart disease were obtained from their medical records. Patients CT angiography were reviewed for recording variables such as main pulmonary artery diameter and right ventricle (RV)/left ventricle (LV) ratio. Patient deaths up to three months since diagnosis of PE had been registered. Logistic regression analysis was performed to find predictors. Results: Based on multiple logistic regression, RV/LV ratio, LV diameter, and right-sided pulmonary infarction are predictors of mortality in 30 days. An RV/LV ratio of 1.19 could successfully discriminate patients who died within 30 days and those who did not. Conclusions: RV/LV ratio, LV diameter, right-sided pulmonary infarction, assessed with helical CT, can help predict 30-day mortality.

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CHA₂DS₂‐VASc and PESI scores are associated with right ventricular dysfunction on computed tomography pulmonary angiography in patients with acute pulmonary thromboembolism

Alirezaei

Mahboubi-Fooladi

Irilouzadian

et al. 2022

Clinical Cardiology

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Background: Accurate risk stratification is the most important step in the management of patients with acute pulmonary thromboembolism (PTE). Pulmonary embolism severity index (PESI) is a clinical tool for PTE risk stratification. CHA 2 DS 2 -VASc score, a risk assessment tool in patients with atrial fibrillation, is recently considered for acute PTE. The presence of right ventricular (RV) dysfunction in imaging is more efficient in acute PTE risk evaluation. Hypothesis: This study aims to evaluate the association between CHA 2 DS 2 -VASc and PESI score and each of them with RV dysfunction on computed tomography pulmonary angiography (CTPA). Methods: One hundred eighteen patients with a definite diagnosis of PTE were entered. The CHA 2 DS 2 -VASc and PESI scores were calculated for all of them. RV dysfunction including an increase in RV to left ventricular diameter ratio, interventricular septal bowing, and reflux of contrast medium into the inferior vena cava was examined by CTPA. Results: PESI and CHA 2 DS 2 -VASc scores were significantly associated with RV dysfunction. In addition, different classes of PESI scores were correlated with RV dysfunction. Moreover, this study showed that the CHA 2 DS 2 -VASc score and PESI score had a positive correlation. The area under the curve value for the CHA 2 DS 2 -VASc score was 0.625 with 61.54% sensitivity and 60.0% specificity for predicting RV dysfunction while for PESI score was 0.635 with 66.7% sensitivity and 60.0% specificity. Conclusion: This study showed that not only CHA 2 DS 2 -VASc and PESI scores are positively correlated, but they are both associated with RV dysfunction diagnosed by CTPA. CHA 2 DS 2 -VASc and PESI scores are able to predict RV dysfunction.

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Septal bowing and pulmonary artery diameter on computed tomography pulmonary angiography are associated with short-term outcomes in patients with acute pulmonary embolism

Cited by 28 publications

References 38 publications

The assessment of acute pulmonary embolism severity using CT angiography features

The assessment of acute pulmonary embolism severity using CT angiography features

Computed tomography pulmonary angiography for acute pulmonary embolism: prediction of adverse outcomes and 90-day mortality in a single test

CHA₂DS₂‐VASc and PESI scores are associated with right ventricular dysfunction on computed tomography pulmonary angiography in patients with acute pulmonary thromboembolism

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Septal bowing and pulmonary artery diameter on computed tomography pulmonary angiography are associated with short-term outcomes in patients with acute pulmonary embolism

Cited by 28 publications

References 38 publications

The assessment of acute pulmonary embolism severity using CT angiography features

The assessment of acute pulmonary embolism severity using CT angiography features

Computed tomography pulmonary angiography for acute pulmonary embolism: prediction of adverse outcomes and 90-day mortality in a single test

CHA2DS2‐VASc and PESI scores are associated with right ventricular dysfunction on computed tomography pulmonary angiography in patients with acute pulmonary thromboembolism

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CHA₂DS₂‐VASc and PESI scores are associated with right ventricular dysfunction on computed tomography pulmonary angiography in patients with acute pulmonary thromboembolism