The Prognostic Significance of Pulmonary CT Angiography in Predicting the Outcomes of Acute Pulmonary Thromboembolism

Abstract

Background: Pulmonary embolism (PE) is a potentially fatal condition. Knowledge of the prognostic factors for PE may facilitate the management of these patients. Pulmonary CT angiography (PCTA) can play an effective role in their management. Objectives: To evaluate the prognostic value of certain PCTA-derived indicators of right ventricular dysfunction in patients with acute PE. Methods: A total of 61 hemodynamically stable patients with acute PE underwent PCTA and were followed-up for 60 days. The Qanadli index and 60-day mortality represented the PE severity and prognostic endpoints, respectively. The clinical significance of the following variables in predicting PE severity and mortality was examined: an abnormally positioned interventricular septum, right ventricular to left ventricular diameter ratio (RVD/LVD) on the axial plane, contrast medium reflux into the inferior vena cava (IVC), transverse diameter of the pulmonary trunk, and bolus-time curve indicators. Results: The 60-day mortality was estimated at 14.8% in this study. An abnormal interventricular septum morphology, RVD/LVD ratio, and contrast medium reflux into the IVC were significantly correlated with the Qanadli index. The pulmonary trunk diameter was the only predictor of 60-day mortality (optimal cutoff value, 33.5 mm; sensitivity, 66.7%; and specificity, 65.4%). The bolus-time curve indicators did not have any significant predictive value. Conclusion: Some PCTA-derived indicators of right ventricular dysfunction may serve as severity/prognostic predictors in hemodynamically stable patients with acute PE.