The efficacy of CT for detection of right ventricular dysfunction in acute pulmonary embolism, and comparison with cardiac biomarkers

İn, Erdal; Aydin, Ayşe; Özdemir, Cengiz; Sökücü, Sinem Nedime; Dağlı, Mustafa

doi:10.1007/s11604-015-0447-9

Cited by 10 publications

(8 citation statements)

References 28 publications

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“…For example, in COPD, an elevated NT-proBNP is a strong predictor of early mortality among patients admitted to hospital with AECOPD, independently of other known prognostic indicators. 8 BNPs have been found to correlate with several radiologically relevant endpoints including right ventricular enlargement detected on chest computed tomography (CT) in patients with acute pulmonary embolism 9 , 10 and coronary atherosclerosis on angiography. 11 C-reactive protein (CRP) is also an important biomarker in AECOPD.…”

Section: Introductionmentioning

confidence: 99%

Phenotyping COPD exacerbations using imaging and blood-based biomarkers

Alotaibi¹,

Chen²,

Hollander³

et al. 2018

COPD

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RationaleAcute exacerbations of chronic obstructive pulmonary disease (AECOPD) are caused by a variety of different etiologic agents. Our aim was to phenotype COPD exacerbations using imaging (chest X-ray [CXR] and computed tomography [CT]) and to determine the possible role of the blood tests (C-reactive protein [CRP], the N-terminal prohormone brain natriuretic peptide [NT-proBNP]) as diagnostic biomarkers.Materials and methodsSubjects who were hospitalized with a primary diagnosis of AECOPD and who had had CXRs, CT scans, and blood collection for CRP and NT-proBNP were assessed in this study. Radiologist blinded to the clinical and laboratory characteristics of the subjects interpreted their CXRs and CT images. ANOVA and Spearman’s correlation were performed to test for associations between these imaging parameters and the blood-based biomarkers NT-proBNP and CRP; logistic regression models were used to assess the performance of these biomarkers in predicting the radiological parameters.ResultsA total of 309 subjects were examined for this study. Subjects had a mean age of 65.6±11.1 years, 66.7% of them were males, and 62.4% were current smokers, with a mean FEV1 54.4%±21.5% of predicted. Blood NT-proBNP concentrations were associated with cardiac enlargement (area under the curve [AUC] =0.72, P<0.001), pulmonary edema (AUC =0.63, P=0.009), and pleural effusion on CXR (AUC =0.64, P=0.01); whereas on CT images, NT-proBNP concentrations were associated with pleural effusion (AUC =0.71, P=0.002). Serum CRP concentrations, on the other hand, were associated with consolidation on CT images (AUC =0.75, P<0.001), ground glass opacities (AUC =0.64, P=0.028), and pleural effusion (AUC =0.72, P<0.001) on CT images. A serum CRP sensitivity-oriented cutoff point of 11.5 mg/L was selected for the presence of consolidation on CT images in subjects admitted as cases of AECOPD, which has a sensitivity of 91% and a specificity of 53% (P<0.001).ConclusionElevated CRP may indicate the presence of pneumonia, while elevated NT-proBNP may indicate cardiac dysfunction. These readily available blood-based biomarkers may provide more accurate phenotyping of AECOPD and enable the discovery of more precise therapies.

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Section: Introductionmentioning

confidence: 99%

Phenotyping COPD exacerbations using imaging and blood-based biomarkers

Alotaibi¹,

Chen²,

Hollander³

et al. 2018

COPD

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“…Moreover, CTA signs such as the right-to-left ventricular ratio, or reflux of contrast media in the hepatic veins are now well recognized and can help in patient management. Increased right-to-left ventricular ratio correlates with RVD assessed on echocardiography [14–16], all-causes mortality, PE-related mortality, and other composite outcomes [13, 17, 18]. In RDV diagnosed by echocardiography, the sensitivity and specificity of right-to-left ventricular ratio (≥1) measured by CTA are 91% (95% CI 72–99%) and 79% (95% CI 69%-87%), respectively [19].…”

Section: Introductionmentioning

confidence: 99%

Contrast Circulation Time to Assess Right Ventricular Dysfunction in Pulmonary Embolism: A Retrospective Pilot Study

John¹,

Platon

Poletti

et al. 2016

PLoS ONE

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ObjectiveTo optimize enhancement of pulmonary arteries and facilitate diagnosis of pulmonary embolism (PE), modern computed tomography angiography (CTA) contains a contrast bolus tracking system. We explored the diagnostic accuracy of the time-intensity curves given by this automated system to identify right ventricular dysfunction (RVD) in acute PE.Methods114 CTAs with a diagnosis of PE were reviewed. RVD was defined as right-to-left ventricular diameter ratio of 1 or greater. Four parameters on time-intensity curves were identified. Parameters between CTAs with and those without RVD were compared with the Wilcoxon rank-sum test. The ability of the four parameters to discriminate patients with RVD was explored by compiling the area under the operating curves (AUC).ResultsThe time needed by the contrast media to reach the pulmonary artery [8 seconds (IQR: 7–9) versus 7 seconds (IQR: 6–8), p<0.01], the time needed to reach 40 Hounsfield units (HU) [11 seconds (IQR: 8.5–14) versus 9.5 seconds (IQR: 8–10.5), p<0.01], and the contrast intensity reached after 10 seconds [19 HU (IQR: 4–67) versus 53 HU (IQR: 32–80), p<0.05] were all statistically different between CTA with and CTA without RVD. Those three parameters changed gradually across severity categories of RVD (p<0.05 for trend). Their AUC to identify RVD ranged from 0.63 to 0.66. The slope of contrast intensity over time was not informative: [31 HU/s (IQR: 20–57) in CTA with, compared to 36 HU/s (IQR: 22.5–53) in CTA without RVD, p = 0.60].ConclusionSeveral parameters of the time-intensity curve obtained by the bolus tracking system are associated with RVD assessed on CTA images. Of those, the time needed to reach a predefined threshold seems to be the easiest to obtain in any CTA without additional processing time or contrast injection. However, the performance of those parameters is globally low.

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“…Echocardiography is the recommended imaging method for evaluation of RVD and outcome of PTE, especially in hemodynamically unstable patients. [ 34 35 ] George et al . have demonstrated that right ventricular (RV) strain in echocardiography could predict PE-related 30-day mortality.…”

Section: Discussionmentioning

confidence: 99%

Clinical and echocardiographic findings of patients with suspected acute pulmonary thromboembolism who underwent computed tomography pulmonary angiography

et al. 2016

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Background:The aim of the study was to determine the correlation between clinical and echocardiographic findings and risk factors of patients with suspected acute pulmonary thromboembolism (PTE) who underwent computed tomography pulmonary angiography (CTPA).Materials and Methods:In this cross-sectional study, 310 hospitalized patients aged >18 years with high clinical suspicion of PTE referred to imaging center of our hospital from different wards for CTPA were enrolled. The frequency of different clinical presentations, risk factors, items of Wells’ criteria, and echocardiographic findings was compared in patients with and without PTE, which have been diagnosed according to the CTPA results.Results:PTE was diagnosed in 53 (17.1%) of patients with suspected PTE. From clinical manifestations, tachypnea, pleuritic chest pain, and edema of lower extremities were significantly more frequent among patients with PTE (P < 0.05). Major surgery was the risk factor which was significantly more prevalent among patients with PTE (P < 0.05). Frequency of all criteria of Wells’ criteria, except hemoptysis, was significantly higher in patients with PTE (P < 0.05). The frequency of all studied echocardiographic variables was significantly higher in patients with PTE (P < 0.05).Conclusion:It is suggested that we could use the results of this study for utilizing the diagnostic process of PTE in patients with highly clinical suspicion of PTE and providing more validated decision. Using the results of this study, we could identify high-risk patients and made appropriate risk assessment for better management of patients with suspected PTE as well as reduce the rate of unnecessary CTPA and its related adverse consequences.

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The efficacy of CT for detection of right ventricular dysfunction in acute pulmonary embolism, and comparison with cardiac biomarkers

Abstract: It was found that CTPA findings were significantly associated with the presence of RVD in ECHO, cardiac biomarkers, and mortality of patients with acute PE.

Cited by 10 publications

References 28 publications

Phenotyping COPD exacerbations using imaging and blood-based biomarkers

Phenotyping COPD exacerbations using imaging and blood-based biomarkers

Contrast Circulation Time to Assess Right Ventricular Dysfunction in Pulmonary Embolism: A Retrospective Pilot Study

Clinical and echocardiographic findings of patients with suspected acute pulmonary thromboembolism who underwent computed tomography pulmonary angiography

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