Computed tomographic pulmonary angiography in the assessment of severity of acute pulmonary embolism and right ventricular dysfunction

Nural, Mehmet Selim; Elmalı, Muzaffer; Fındık, Serhat; Yapici, Oktay; Uzun, Oğuz; Sünter, Ahmet Tevfik; Erkan, Levent

doi:10.1080/02841850902902532

Cited by 42 publications

(33 citation statements)

References 35 publications

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“…10 Our results show a highly significant association between the Qanadli score and RV/LV ratio, which is supported by other reports of a strong positive correlation between the mean obstruction score (calculated with the Qanadli method) and mean RV/LV ratio, a significant correlation between the Qanadli obstruction score and RV/LV ratio, and a correlation between RV/LV ratio and mortality. [22][23][24][25] Our results do not confirm those of Araoz et al who reported no correlation between RV/LV ratio and mortality rate. 24 In 108 consecutive patients, Ozsu et al showed the correlation of biomarkers and right/left ventricular dimension ratio ≥1.1 on CTPA with mortality.…”

Section: Figure4contrasting

confidence: 57%

Correlation of Computerized Tomography Angiographic Pulmonary Artery Obstruction Score with Hematologic Outcome and Mortality in Patients with Acute Pulmonary Embolism

Yesildag¹,

Keskin²,

Güler³

et al. 2013

Turkiye Klinikleri J Med Sci

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A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The aim of this study was to determine the relationship between the computed tomography obstruction score and radiological parameters, biochemical parameters, and mortality. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : During an 8-month period (January 2011-August 2011), 326 patients with clinically suspected pulmonary embolism (PE) were examined by computerized tomography pulmonary angiography (CTPA). Of these patients, only 95 (49 men and 46 women) were diagnosed with PE. Computerized tomography images were retrieved from the picture archiving and communication system (PACS) for the determination of right ventricle/left ventricle (RV/LV) shortaxis ratio, maximum diameter of the pulmonary artery, and vascular obstruction score according to Qanadli method. We investigated the correlation between continuous values of the Qanadli scoring system and mortality, and determined whether there was a significant difference between mortality and CTPA parameters. The values derived from the morphologic changes in the CTPA, hematological findings and gender where then assessed with respect to their impacts on mortality. R Re es su ul lt ts s: : There was a significant correlation between the PE obstruction score and RV/LV short-axis ratio (r=0.58, p<0.001), RV/LV short-axis ratio, and neutrophil to lymphocyte ratio (NLR) (r=0.21, p=0.035). Survivors and non-survivors had a statistically significant difference in the NLR and midplatelet volume (MPV) (p<0.05). The mortality incidence in patients with an increased MPV (odds ratio 1.689; 95% confidence interval (CI) 1.06-2.67; p=0.025) and older female patients (odds ratio 3.732; 95% CI 1.02-13.65; p=0.04) was higher. C Co on nc cl lu us si io on n: : Our results suggest that in patients with acute PE, NLR and MPV may be of value for the estimation of mortality.K Ke ey y W Wo or rd ds s: : Pulmonary embolism; multidetector computed tomography Ö ÖZ ZE ET T A Am ma aç ç: : Bu çalışmanın amacı, bilgisayarlı tomografi obstrüksiyon skoru ile radyolojik, biyokimyasal parametreler ve mortalite arasındaki ilişkiyi belirlemektir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Sekiz aylık periyotta (Ocak 2011-Ağustos 2011), klinik olarak pulmoner emboli kuşkulu 326 hasta bilgisayarlı tomografi pulmoner anjiyografi (BTPA) ile incelendi. Bunların sadece 95'i (49 erkek, 46 kadın) pulmoner emboli tanısı aldı. Bilgisayarlı tomografi imajları sağ ventrikül/sol ventrikül kısa aks oranlarını, pulmoner arter maksimum çapını ve Qanadli obstrüksiyon skorunu saptamak için gö-rüntü saklama ve iletişim sisteminden çağrıldı. Qanadli obstrüksiyon skoru ile mortalite arasındaki ilişki incelendi. Mortalite ve bilgisayarlı tomografi pulmoner anjiyografi parametreleri arasında anlamlı farklılık olup olmadığı araştırıldı. Bilgisayarlı tomografi pulmoner anjiyografideki morfolojik değişikliklerden elde edilen değerler, hematolojik bulgular, cinsiyet ve bunların mortalite üzerin-deki etkileri değerlendirildi. B Bu ul lg gu ul la ar r...

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Section: Figure4contrasting

confidence: 57%

Correlation of Computerized Tomography Angiographic Pulmonary Artery Obstruction Score with Hematologic Outcome and Mortality in Patients with Acute Pulmonary Embolism

Yesildag¹,

Keskin²,

Güler³

et al. 2013

Turkiye Klinikleri J Med Sci

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“…15 studies were initially excluded [10,19,20,22,26,31,33,35,38,39,41,43,46,50,52]. For six of them, the inclusion in the analysis was possible following contact with the authors [22,35,38,39,43,52].…”

Section: Meta-analysis Of Ct Assessed Right Ventricle Dilationmentioning

confidence: 99%

Computed tomography to assess risk of death in acute pulmonary embolism: a meta-analysis

Becattini

Agnelli

Germini

et al. 2014

European Respiratory Journal

144

100

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The aim of this study was to evaluate whether right ventricle dilation at computed tomography (CT) angiography can be used to assess the risk of death in patients with acute pulmonary embolism.Medline and EMBASE were searched up to April 30, 2013. Studies reporting on the association between right ventricle dilation (right-to-left ventricle diameter) or dysfunction (inter-ventricular septal bowing) at CT angiography and death at 30 days, as well as at 3 months in patients with acute pulmonary embolism, were included in a systematic review and meta-analysis.CT-detected right ventricle dilation was associated with an increased 30 day-mortality in all-comers with pulmonary embolism (OR 2.08 (95% CI 1.63-2.66); p,0.00001) and in haemodynamically stable patients (OR 1.64 (95% CI 1.06-2.52); p50.03), as well as with death due to pulmonary embolism (OR 7.35 (95% CI 3.59-15.09); p,0.00001). An association between right ventricle dilation and 3-month mortality was also observed (OR 4.65 (95% CI 1.79-12.07); p50.002).Right-to-left ventricle dilation as assessed by CT angiography can be used to evaluate risk of death in allcomers with pulmonary embolism and in haemodynamically stable patients. @ERSpublications Multidetector CT can be used to assess short-term risk of death in patients with acute pulmonary embolism

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“…Another strength of our subjective interpretation strategy is that it mitigates ambiguity introduced from different RV/LV diameter ratio cutoff values used to predict outcomes, varying in the literature from 0.9 to 1.0 for 4-chamber measurements [8,9,13,17] and from 0.9 to 1.5 for axial measurements [6,12,14,15,17,18,[23][24][25]. We applied a 1.0 threshold for objective measurements when compared to visual assessment because it is supported by the data (Fig.…”

Section: Discussionmentioning

confidence: 98%

Subjective assessment of right ventricle enlargement from computed tomography pulmonary angiography images

Kumamaru

Bedayat

Soga

et al. 2011

Int J Cardiovasc Imaging

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To retrospectively evaluate prognostic accuracy of subjective assessment of right ventricle (RV) enlargement on CT pulmonary angiography (CTPA) images in comparison with objective measures of RV enlargement in patients with acute pulmonary embolism (PE). For 200 consecutive patients with acute PE, two readers blinded to patient outcomes subjectively determined whether the maximum RV diameter was greater than that of the left ventricle (LV) using axial CTPA images. For the objective measurements, RV/LV diameter ratios were calculated using axial images and 4-chamber reformatted images. For all assessments, sensitivities and specificities for predicting PE-related death within 30-days and a composite outcome including PE-related death or the need for intensive therapies were compared. The agreement between two readers was 91.5% (kappa = 0.83) and all other assessments had pair-wise agreement over 75% (kappa = 0.53-0.72). There was no significant difference in sensitivity between the subjective and objective methods for predicting both outcomes. The specificity for subjective RV enlargement (55.4-67.7%) was significantly higher than objective measures (45.8-53.1%), except for the 4-chamber views where, for one reader, the specificity of the subjective evaluation was higher but did not reach statistical significance. Complex measurements of RV/LV diameter ratios may not be needed to maximize the prognostic value from CTPA. The radiologist who interprets the CTPA images should report RV enlargement when the RV diameter subjectively appears larger than the LV.

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Computed tomographic pulmonary angiography in the assessment of severity of acute pulmonary embolism and right ventricular dysfunction

Abstract: This study found that the parameters useful for distinguishing HUPE and HSPE included CTPA obstruction score, RV and SVC diameters, RV/LV short-axis ratio, interventricular septum shape, and reflux into the IVC. RV dilatation may be a significant predictor for mortality.

Cited by 42 publications

References 35 publications

Correlation of Computerized Tomography Angiographic Pulmonary Artery Obstruction Score with Hematologic Outcome and Mortality in Patients with Acute Pulmonary Embolism

Correlation of Computerized Tomography Angiographic Pulmonary Artery Obstruction Score with Hematologic Outcome and Mortality in Patients with Acute Pulmonary Embolism

Computed tomography to assess risk of death in acute pulmonary embolism: a meta-analysis

Subjective assessment of right ventricle enlargement from computed tomography pulmonary angiography images

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