Association between computed tomography obstruction index and mortality in elderly patients with acute pulmonary embolism: A prospective validation study

Background: The 2019 European Society of Cardiology (ESC) guidelines recommend evaluation for right ventricular dysfunction in all normotensive patients with acute pulmonary embolism (PE). We compared the predictive performance of the 2019 and 2014 ESC risk stratification algorithms and the Pulmonary Embolism Severity Index (PESI). Methods: We performed a post-hoc analysis of normotensive patients aged ≥65 years with acute PE from a prospective cohort. The primary outcome was overall mortality; secondary outcomes were PE-related mortality and adverse outcomes (PE-related death, cardiopulmonary resuscitation, intubation, catecholamine use, recurrent venous thromboembolism) at 30 days. We assessed outcomes in intermediate-high, intermediate-low, and low risk groups according to the 2019 and 2014 ESC algorithms and the PESI. Discriminative power was compared using the area under the receiver operating curve (AUC). Results: Among 419 patients, 14 (3.3%) died (7 from PE) and 16 (3.8%) had adverse outcomes within 30 days. The 2019 ESC algorithm classified more patients as intermediate-high risk (45%) than the 2014 ESC algorithm (24%) or PESI (37%), and only 19% as low risk (32% with 2014 ESC or PESI). Discriminatory power for overall mortality was lower with the 2019 ESC algorithm (AUC 63.6%), compared to the 2014 ESC algorithm (AUC 71.5%) or PESI (AUC 75.2%), although the difference did not reach statistical significance (p=0.063). Discrimination for PE-related mortality and adverse outcomes was similar. Conclusions: While categorizing more patients in higher-risk groups, the 2019 ESC algorithm for PE did not improve prediction of short-term outcomes compared to the 2014 ESC algorithm or the PESI.

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“…RV dysfunction on CTPA was independently assessed by two radiologists and defined as RV/LV (left ventricle) diameter ratio of !1.0. 4,16…”

Section: Assessment Of Rv Functionmentioning

confidence: 99%

Validation of the 2019 European Society of Cardiology Risk Stratification Algorithm for Pulmonary Embolism in Normotensive Elderly Patients

et al. 2021

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“…As the prevalence and severity of OSA is increasing with age, our findings might, at least in part, explain results of another study indicating a lower prognostic value of the RV/LV diameter ratio in elderly patients with acute PE. 22 …”

Section: Discussionmentioning

confidence: 99%

Right-to-left Ventricular Diameter Ratio At Computed Tomographic Pulmonary Angiography in Patients with Acute Pulmonary Embolism and Obstructive Sleep Apnea

Berghaus

Konnerth

Probst

et al. 2020

Clin Med Insights Circ Respir Pulm Med

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Purpose: Right ventricular (RV) dysfunction in acute pulmonary embolism (PE) is a critical determinant of outcome. Obstructive sleep apnea (OSA) is a common comorbidity of PE and might also affect RV function. Therefore, we sought to investigate RV dysfunction in PE patients in proportion to the severity of OSA by evaluating the right-to-left ventricular (RV/LV) diameter ratio on computed tomographic pulmonary angiography (CTPA). Materials and Methods: 197 PE patients were evaluated for sleep-disordered breathing by portable monitoring and nocturnal polysomnography. RV dilatation was defined as an RV/LV diameter ratio of ⩾ 1.0. Results: RV dilatation was significantly more frequent in OSA patients compared to study participants without OSA (66.4% vs 49.1%, P = .036). Elevated troponin I values, indicating myocardial injury due to acute, PE-related RV strain, were significantly more frequent in OSA patients with an apnea-hypopnea index (AHI) ⩾ 15/h compared to those with an AHI < 15/h (62.1% vs 45.8%, P = .035). However, RV dysfunction documented by the RV/LV diameter ratio on CTPA was not significantly associated with the severity of OSA in multivariable regression analysis. Conclusion: Patients with moderate or severe OSA might compensate acute, PE-related RV strain better, as they are adapted to repetitive right heart pressure overloads during sleep.

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“…Miller (1971 г. ), при помощи которых возможна количественная оценка степени тяжести ТЭЛА [8][9][10].…”

Section: Introductionunclassified

Predicting the Success of Emergency Surgical Treatment of Acute Massive Pulmonary Embolism Based on the Results of Multislice Computed Tomography

Trofimova

Sukhova²

2020

Vestn. rentgenol. radiol.

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Objective – to assess the informativeness of multisclice computed tomography (MSCT) angiopulmonography in the assessment of peripheral blood flow and to determine the prognostic role of angiographic massiveness and volume of preserved peripheral blood flow as predictors of success of emergency surgical treatment of acute massive pulmonary embolism (PE). Material and methods. The article presents the results of 7-year work for the period from March 2012 to September 2019, which included a pilot retrospective stage (analysis of the results of 264 MSCT procedures with contrast enhancement for acute PE in patients aged 32 to 69 years for the period 2012–2013) and prognostic practical work (the second stage, analysis of the results of 974 MSCT procedures with contrast enhancement in patients aged 25 to 78 years for the period 2013–2019).Results. The obtained results and statistical dependences proved the influence of the saved volume of peripheral arterial pulmonary blood flow on the outcome of surgical treatment. The use of this indicator as an MSCT predictor reduced the hospital mortality rate from 7.2% to 3.5%. The analysis of the influence of the initial angiographic massiveness of PE on the outcome of surgical treatment has not been confirmed.Conclusion. According to the results of the study, we recommend the inclusion of segmental arterial pulmonary blood flow analysis by MSCT with contrast enhancement in the algorithm of preoperative examination of patients with acute massive pulmonary embolism in case of emergency surgical treatment.

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Association between computed tomography obstruction index and mortality in elderly patients with acute pulmonary embolism: A prospective validation study

Cited by 19 publications

References 37 publications

Validation of the 2019 European Society of Cardiology Risk Stratification Algorithm for Pulmonary Embolism in Normotensive Elderly Patients

Validation of the 2019 European Society of Cardiology Risk Stratification Algorithm for Pulmonary Embolism in Normotensive Elderly Patients

Right-to-left Ventricular Diameter Ratio At Computed Tomographic Pulmonary Angiography in Patients with Acute Pulmonary Embolism and Obstructive Sleep Apnea

Predicting the Success of Emergency Surgical Treatment of Acute Massive Pulmonary Embolism Based on the Results of Multislice Computed Tomography

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