Transthoracic Echocardiography and Chest Computed Tomography Arteriography in Patients with Acute Pulmonary Embolism: A Two-Year Follow-Up Study

Abstract

Background: Pulmonary hypertension (PH) is frequently found at the time of diagnosis of pulmonary embolism (PE). An incomplete resolution of PE can lead to chronic thromboembolic pulmonary hypertension (CTPH). Transthoracic echocardiogram (TTE) is the first step to diagnose an abnormality of the pulmonary vasculature. Based on computed tomography (CT), the Qanadli vascular obstruction index has been extensively used to assess acute PE. Objectives: Our aim was to ascertain whether at the time of diagnosis of an acute PE episode TTE variables and a Qanadli CT index score may be associated with CTPH 2 years later. Method: Patients with PE were prospectively enrolled. TTE was performed and the Qanadli CT obstruction index was calculated on admission to the hospital, while only TTE was repeated at the 2-year follow-up. The NYHA (New York Heart Association) functional classification was evaluated. Correlation analyses were performed. Results: Twenty patients (11 males, median age 69.5 years) were considered for the study. There was no significant correlation between TTE parameters and the Qanadli CT obstruction index. A significant distribution (χ² = 5.69, p = 0.017) was found in the analysis among patients with CTPH at 24 months and the Qanadli CT index, categorized by a receiver operating characteristic curve cutoff value of 42.5%. Additionally, a significant distribution (χ² = 4.09, p = 0.043) was found in the analysis among patients with CTPH at 24 months and right ventricular systolic pressure on admission, categorized as PH (>31 mm Hg). Conclusion: Our study demonstrates that in patients with acute PE there is no relationship between the Qanadli CT obstruction index and TTE parameters on admission to the hospital. However, the occurrence of CTPH at the 24-month follow-up is associated with PH and with a high Qanadli CT obstruction index score.

Evaluation of factors affecting 90-day mortality in patients hospitalized due to pulmonary thromboembolism

“…PTE is a significant cause of mortality and morbidity. In previous studies, 90-day mortality rate has been reported as 58.3% in patients with massive PTE and as 15.1% in patients with submassive PTE (11,18). In our study, massive (15.3%) and submassive (6.5%) PTE ratio has been lower than studies where 90 days of mortality have been evaluated.Hospital stay in patients with acute PTE has been reported to vary between 4 and 10 days (19,20).…”

“…In our study, however, the prevalence of systemic thrombolytic therapy was higher than those reported in the literature, which could be associated with several factors including the high rate of ICU hospitalization (28.4%), high APACHE II scores and PAP values, and high prevalence of vasopressor requirement, hemodynamic instability, and RVD in our patients. On the other hand, the prevalence of full-dose rtPA therapy was higher than that of half-dose rtPA therapy (56.1% vs. 43.9%) (11,16,17). However, no significant difference was found between these two groups with regard to PAP and the prevalence of RVD, both of which are significant pathfinders in the decision-making processes regarding thrombolytic therapy and its dosage.…”

Application of CT pulmonary angiography and echocardiography in acute pulmonary embolism: A cross‐sectional study

“…Surprisingly, a study proposed that serum NT‐proBNP and troponin T levels can be superior to the combination of biomarkers and right ventricular dysfunction findings in CTPA/echocardiography in risk stratification of patients with normotensive PE 21 . Moreover, one of the well‐known methods is the CT index, which quantifies the arterial obstruction in PE and highly correlates with CTPA findings 22–24 . Further expansion of these noninvasive and operator‐independent methods could help in the early diagnosis of PE and the successful prediction of its adverse outcomes.…”

“… 21 Moreover, one of the well‐known methods is the CT index, which quantifies the arterial obstruction in PE and highly correlates with CTPA findings. 22 , 23 , 24 Further expansion of these noninvasive and operator‐independent methods could help in the early diagnosis of PE and the successful prediction of its adverse outcomes.…”