One-shot diagnostic and prognostic assessment in intermediate- to high-risk acute pulmonary embolism: the role of multidetector computed tomography

• Main Author: Baptista, Rui Terenas
• Publication Date: 2013
• Other Authors: Santiago, Inês, Jorge, Elisabete, Teixeira, Rogério, Mendes, Paulo, Semedo, Luís Curvo, Castro, Graça, Monteiro, Pedro, Alves, Filipe Caseiro, Providência, Luís A.
• Format: Article
• Language: eng
• Source: Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
• Download full: https://hdl.handle.net/10316/109808; https://doi.org/10.1016/j.repc.2012.05.020
• topic: Pulmonary embolism; Prognosis; Right ventricular dysfunction; Thrombolysis; Multidetector computed tomography; Contrast; Tromboembolia pulmonar; Prognóstico; Disfunção ventricular direita; Trombólise; Tomografia computadorizada; Contraste; Acute Disease; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Prognosis; Pulmonary Embolism; Retrospective Studies; Risk Assessment; Risk Factors; Young Adult; Multidetector Computed Tomography

Introduction: Contrast-enhanced multidetector computed tomography (MDCT) is useful for the diagnosis of pulmonary embolism (PE). However, current guidelines do not support its use for risk assessment in acute PE patients. Objectives: We compared the prognostic impact of MDCT-derived indices regarding mediumterm mortality in a population of intermediate- to high-risk PE patients, mostly treated by thrombolysis. Methods: Thirty-nine consecutive patients admitted to an intensive care unit with acute PE were studied. All patients had a pulmonary MDCT on admission to the emergency room as part of the diagnostic algorithm. We assessed the following MDCT variables: right ventricular/left ventricular diameter (RV/LV) ratio, arterial obstruction index, pulmonary artery-to-aorta diameter ratio and azygos vein diameter. A 33-month follow-up was performed. Results: Mean age was 59.1±19.6 years, with 80% of patients receiving thrombolysis. Followup all-cause mortality was 12.8%. Of the MDCT-derived variables, only the RV/LV ratio had significant predictive value, being higher in patients who suffered the endpoint (1.6±0.5 vs. 1.9±0.4, p=0.046). Patients with an RV/LV ratio ≥1.8 had 11-fold higher medium-term allcause mortality (3.8% vs. 38.8%, p<0.001). Regarding this endpoint, the c-statistic was 0.78 (95% CI, 0.60---0.96) for RV/LV ratio and calibration was good (goodness-of-fit p=0.594). No other radiological index was predictive of mortality. Conclusions: MDCT gives the possibility, in a single imaging procedure, of diagnosing and assessing the prognosis of patients with intermediate- to high-risk PE. Although further studies are needed, the simple-to-calculate RV/LV ratio has good discrimination and calibration for predicting poorer outcomes in patients with acute PE.