Severe Pulmonary Embolism:Pulmonary Artery Clot Load Scores and Cardiovascular Parameters as Predictors of Mortality

Abstract

Purpose:To retrospectively evaluate pulmonary artery (PA) clot load scores and computed tomographic (CT) cardiovascular parameters as predictors of mortality in patients with severe pulmonary embolism (PE). Materials and Methods:Institutional review board approval was obtained with waiver of informed consent. A total of 82 consecutive patients (42 women, 40 men; mean age Ϯ standard deviation, 61 years Ϯ 15) were admitted to the intensive care unit for PE-related conditions and were evaluated by using CT pulmonary angiography. Two independent readers who were blinded to clinical outcome quantified PA clot load by using four scoring systems. Cardiovascular measurements included right ventricular (RV) and left ventricular (LV) short-axis measurements; RV short axis to LV short axis (RV/LV) ratios; main PA, ascending aorta, azygos vein, and superior vena cava diameters; and main PA diameter to aorta diameter ratios. Reflux of contrast medium into the inferior vena cava, leftward bowing of the interventricular septum, pleural or pericardial effusion, pulmonary consolidation, infarct, platelike atelectasis, and mosaic ground-glass opacity were also recorded. Results were correlated with patient outcome during hospital stay by using the Wilcoxon rank sum and 2 tests. Results:Twelve patients died within 1-14 days. RV and LV short axis; RV/LV ratio; azygos vein, superior vena cava, and aorta diameters; and contrast medium reflux into the inferior vena cava were significantly different between survivors and nonsurvivors (P Ͻ .05). No significant relationship was found between PA clot load and mortality rate. RV/LV ratio and azygos vein diameter allowed correct prediction of survival in 89% of patients (P Ͻ .001). Conclusion:RV/LV ratio and azygos vein diameter are predictors of mortality in patients with severe PE.

Dynamic MR perfusion imaging: Capability for quantitative assessment of disease extent and prediction of outcome for patients with acute pulmonary thromboembolism

“…Several previous studies have suggested that pulmonary arterial embolic burden assessed by CT as well as by RV/LV ratio is also a predictor for APTE patients (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). On the other hand, Ghaye et al (19) suggested that RV/LV diameter ratio and azygos vein diameter were significant predictors, and that pulmonary arterial embolic burden was not.…”

“…According to the past literatures (14)(15)(16)(17)(18)(19)(20), the scans were evaluated by measuring the minor axes of the right and left ventricles of the heart in the transverse plane at their widest points between the inner surface of the free wall and the surface of the interventricular septum. These maximum dimensions may be found at different levels.…”

“…Currently, multidetector-row CT (MDCT) pulmonary angiography can be used to identify clots within distal pulmonary arteries (PAs) with high sensitivity and specificity, and can indicate alternative diagnoses and underlying lung diseases. In addition, some investigators have used several parameters to evaluate the accuracy of CT scoring systems for PA clot assessment as well as right ventricular (RV) failure assessment (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). MDCT has therefore become the first imaging examination for suspected acute PTE (APTE) patients (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

“…In addition, some investigators have used several parameters to evaluate the accuracy of CT scoring systems for PA clot assessment as well as right ventricular (RV) failure assessment (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). MDCT has therefore become the first imaging examination for suspected acute PTE (APTE) patients (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). In addition, the ratio between the diameter of the RV and of the left ventricle (LV), the RV/LV ratio, and embolic burden have been associated with patient outcome (11,(16)(17)(18)(19)(20).…”

“…MDCT has therefore become the first imaging examination for suspected acute PTE (APTE) patients (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). In addition, the ratio between the diameter of the RV and of the left ventricle (LV), the RV/LV ratio, and embolic burden have been associated with patient outcome (11,(16)(17)(18)(19)(20).…”