Prognostic value of right atrial dilation in patients with pulmonary embolism

Abstract

AimsRight atrial (RA) dilation and stretch provide prognostic information in patients with cardiovascular diseases. We investigated the prevalence, confounding factors and prognostic relevance of RA dilation in patients with pulmonary embolism (PE).MethodsOverall, 609 PE patients were consecutively included in a prospective single-centre registry between 09/2008 and 08/2017. Volumetric measurements of heart chambers were performed on routine non-electrocardiographic-gated computed tomography (CT) and plasma concentrations of mid-regional pro-atrial natriuretic peptide (MR-proANP) measured on admission. An in-hospital adverse outcome was defined as PE-related death, cardiopulmonary resuscitation, mechanical ventilation or catecholamine administration.ResultsPatients with an adverse outcome (11.2%) had larger RA volumes (median 120 [IQR 84–152] versus 102 [78–134] mL; p=0.013), RA/LA volume ratios (1.7 [1.2–2.4] versus 1.3 [1.1–1.7]; p<0.001) and MR-proANP levels (282 [157–481] versus 129 [64–238] pmol·L−1; p<0.001) compared to patients with a favourable outcome. Overall, 499 patients (81.9%) had a RA/LA volume ratio ≥1.0 and a calculated cut-off value of 1.8 (AUC 0.64 [95%CI 0.56–0.71]) predicted an adverse outcome, both in unselected (OR 3.1, 95%CI 1.9–5.2) and normotensive patients (OR 2.7, 95%CI 1.3–5.6). MR-proANP ≥120 pmol·L−1 was identified as an independent predictor of an adverse outcome, both in unselected (OR 4.6, 95%CI 2.3–9.3) and normotensive patients (OR 5.1, 95%CI 1.5–17.6).ConclusionsRA dilation is a frequent finding in patients with PE. However, the prognostic performance of RA dilation appears inferior compared to established risk stratification markers. MR-proANP predicted an in-hospital adverse outcome, both in unselected and normotensive PE patients, integrating different prognostic relevant information from comorbidities.

Biatrial Volumetric Assessment by Non-ECG-Gated CT Pulmonary Angiography Correlated with Transthoracic Echocardiography in Patients with Normal Diastology

“…The differences in the temporal resolution may account for the inter-technique variability in the measurements. A recent prospective study of 609 patients with acute PE [ 2 ] demonstrated the feasibility of performing fully automated RA volumetric analysis on non-ECG-gated CTPA. Whilst RA dilation was a frequent finding in this population, its prognostic performance was inferior compared to other risk stratification markers.…”

“…Whilst RA dilation was a frequent finding in this population, its prognostic performance was inferior compared to other risk stratification markers. Moreover, in the above study [ 2 ], there were patients with co-morbidities that affected the atrial volumes (elderly male patients with cardiovascular comorbidities had higher volumes whilst cancer patients had lower volumes) and only 25% of the cases had corresponding echocardiography which adds to the difficulty of comparing CT measurement accuracy to other techniques.…”

“…There is an increasing trend to use left atrial (LA) size and function as a morphophysiologic expression to predict cardiovascular mortality in a variety of conditions such as atrial fibrillation, cardiomyopathy, ischemic heart disease, and valvular heart disease [ 1 ]. Right atrial (RA) size has also been shown to be of prognostic relevance in diverse cardiopulmonary disorders such as pulmonary embolism and pulmonary hypertension [ 2 , 3 ]. Cardiac magnetic resonance imaging (MRI) and echocardiography are the two non-invasive imaging techniques that are traditionally used for cardiac chamber quantification.…”

Echocardiographic evaluation of the right atrial size and function: Relevance for clinical practice

“…Two-dimensional (2DE) and three-dimensional (3DE) echocardiography are the most commonly employed noninvasive imaging techniques to evaluate RA size [11] , [12] , [13] . Volumetric assessment of the RA size may be more accurate than linear measurement because RA enlargement is asymmetrical.…”

Fully automatic cardiac four chamber and great vessel segmentation on CT pulmonary angiography using deep learning

“…Measurement of right and left ventricular volume ratio may be a superior approach (13). Right and left atrium measurements on computed tomography (CT) are also known to have diagnostic and prognostic value for pulmonary vascular disease (14)(15)(16)(17)(18). Manual cardiac and pulmonary measurements are limited by their time-consuming nature (14), human error, observer variability (19,20), and observer experience leading to potentially inaccurate predictions and less frequent use.…”