Tuberc Respir Dis.  2010 Sep;69(3):184-190.

Chest CT Parameters to Predict the Major Adverse Events in Acute Submassive Pulmonary Embolism

• Jung SK
• Kim WY
• Lee CW
• Seo DW
• Lee YS
• Lee JH
• Oh BJ
• Kim W
• Lim KS
• Hong SB
• Lim CM
• Koh Y

Abstract

BACKGROUND
The purpose of this study was to determine the prognostic significance of chest computed tomographic (CT) parameters in acute submassive pulmonary embolism (PE).
METHODS
Between January 2006 and December 2009, 268 consecutive patients with acute submassive PE that was confirmed by chest CT with pulmonary angiography in emergency room were studied. One experienced radiologist measured CT parameters and judged the presence of right ventricular dysfunction. CT parameters were analyzed to determine their ability to predict a major adverse event (MAE).
RESULTS
There were 220 patients included and 61 (27.7%) had MAE. Left ventricular and right ventricular maximum minor axis (36.4+/-8.0 vs. 41.7+/-7.4, p<0.01; 45.7+/-9.4 vs. 41.5+/-7.6, p<0.01), superior vena cava diameter (19.2+/-3.4 vs. 18.0+/-3.4, p=0.02), azygos vein diameter (10.0+/-2.2 vs. 9.2+/-2.3, p=0.02), septal displacement (19 vs. 18, p<0.01) were significantly higher in MAE group than in no MAE group. Patients with MAE had high right ventricular/left ventricular dimension ratio (RV/LV ratio) compared to patients without MAE (1.34+/-0.48 vs. 1.03+/-0.28, p<0.01). The most useful cut-off value of RV/LV ratio for MAE was 1.3 and the area under the curve was 0.71 (0.62~0.79).
CONCLUSION
RV/LV ratio on chest CT was a significant predictor of submassive PE related shock, intubation, in-hospital mortality, thrombolysis, thrombectomy within 30 days.

Keyword

Pulmonary Embolism; Tomography; Prognosis

MeSH Terms

Angiography
Axis, Cervical Vertebra
Azygos Vein
Displacement (Psychology)
Emergencies
Hospital Mortality
Humans
Intubation
Prognosis
Pulmonary Embolism
Shock
Thorax
Thrombectomy
Vena Cava, Superior
Ventricular Dysfunction, Right

Figure

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  Figure 1 Selection of patients.

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  Figure 2 Receiver operating characteristic curve for predicting major adverse events with RV/LV dimension ratio on 16 slice multidetector scanner.

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