Diagnostic implications of computed tomography pulmonary angiography in patients with pulmonary embolism

Abstract

INTRODUCTION:Pulmonary embolism (PE) is a serious cardiovascular and pulmonary complication worldwide. We aimed to assess the implications of different computed tomography pulmonary angiography (CTPA) parameters in patients with acute PE.METHODS:A retrospective observational study to include patients presented with clinical suspicious of PE who underwent CTPA was conducted. Patients' demographics, clinical presentation, risk factors, laboratory investigations, management, and outcome were analyzed. Computed tomography findings included clot burden (Qanadli score [QS]) and right ventricular dysfunction (RVD) parameters.RESULTS:A total of 45 patients with radiologically confirmed diagnosis of PE were included in the study; of these patients, 8 (17.8%) died during the hospital course. Patients who died were 13 years older than those who survived, and the mortality rate was significantly higher in patients with cancer. The two groups were comparable for cardiovascular parameters. The mean clot burden (QS) was 19.5 ± 11.3 points and 53% of patients had QS >18 points. Obesity (52.4% vs. 12.5%; P = 0.01), hypertension (54.4% vs. 23.8%; P = 0.03), and median D-dimer levels (7.8 vs. 3.4; P = 0.03) were significantly higher in patients with QS >18. Among right ventricular (RV) dysfunction parameters, only higher RV/left ventricular (LV) ratio (P = 0.001) and bowing of interventricular septum (P = 0.001) were associated with higher QS. A significant positive correlation was found between RV short axis (r = 0.499, P = 0.001), RV/LV ratio (r = 0.592, P = 0.001), and pulmonary artery (PA) diameter (r = 0.301, P = 0.04) with the PA clot burden. Receiver operating characteristic curve for clot burden showed a cutoff value of 17.5 points to accurately predict RV dysfunction.CONCLUSIONS:Clot burden >18 is associated with RV dysfunction in patients with acute PE. Echocardiography and RVD parameters showed no correlation with in-hospital deaths. CTPA has clinicoradiological implications for risk stratification in PE patients. As the sample size is small, our findings warrant further larger prospective studies.

<p>Prevalence and Outcomes of Thrombophilia in Patients with Acute Pulmonary Embolism</p>

“…3 In the present study the proportion of males was slightly higher than females, which is consistent with an earlier study from our center and in the region. 26,27 Also, PE patients with thrombophilia were more likely to be younger and more frequently had a history of recurrent VTE than those without thrombophilia. Notably, there is a steep decline in the frequency of hereditary thrombophilia with age in our cohort, which is also evident from findings of the MAISTHRO registry suggesting that this could be attributed to the decrease in frequency of genetic defects and deficiency of PC or PS in individuals that developed an initial VTE event at an advanced age.…”

Reproducibility of thrombus volume quantification in multicenter computed tomography pulmonary angiography studies

“…Emboli to the lungs cause physical obstruction of the pulmonary arteries yielding a pathophysiologic cascade resulting in varying degrees of cardiovascular distress[ 19 ]. Although the embolic load and distribution are considered less pertinent than the patient’s hemodynamic status in evaluating risk stratification[ 7 ] clot burden has been shown to have predictive value of mortality in patients with acute PE[ 20 ]. For example, Collomb et al[ 21 ] have shown that the hemodynamic severity of acute PE can be determined by assessing clot burden through the use of a vascular obstruction index as well as other vascular load measurements such as right ventricular (RV): left ventricular (LV) ratio, minimum LV diameter and diameter of the central PA[ 21 ].…”

Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism

“…61 The location and extent of clot is known to be associated with evidence of heart dysfunction. 62,63 Quantity of clot can be integrated into models to predict right ventricular dysfunction, 64 including those assessing maximal clot size. 65 While these methods are promising, further studies to build consensus on the best method of measuring clot burden are ongoing.…”