Widening of coronary sinus in CT pulmonary angiography indicates right ventricular dysfunction in patients with acute pulmonary embolism

Staśkiewicz, Grzegorz; Czekajska−Chehab, Elżbieta; Przegaliński, J; Tomaszewski, A.; Torres, Kamil; Torres, Anna; Trojanowska, Agnieszka; Maciejewski, Ryszard; Drop, Andrzej

doi:10.1007/s00330-009-1702-1

Cited by 9 publications

(8 citation statements)

References 26 publications

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“…Modern pCTA is capable of clearly illustrating intraluminal clots up to subsegmental arteries [7,8]. Besides, the method can point out indirect effects of PE to the cardiac level with changes in vessel diameters, interventricular septum deviation, and reflux of contrast medium into the venous system (VCR) [5,6,9]. The severity of PE can be evaluated with CTA by using different scoring systems that were derived from conventional angiography studies [10] and adapted to pCTA [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Multidetector-CT angiography in pulmonary embolism—can image parameters predict clinical outcome?

et al. 2011

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Section: Introductionmentioning

confidence: 99%

Multidetector-CT angiography in pulmonary embolism—can image parameters predict clinical outcome?

et al. 2011

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“…After screening by title and abstract and full‐text review, 26 studies ( n = 3508 patients) were included (Figure 1). 11–36 Study characteristics are shown in Table 1, with further details in Table S1. The mean or median age of included patients ranged from 41 to 70 years and between 20% and 64% were female.…”

Section: Resultsmentioning

confidence: 99%

“…All echocardiography in included studies was transthoracic echocardiography. The individual measures used to assess RV dysfunction on CT scan were increased RV/LV ratio with varying cutoffs (24 studies 11–22,24–28,30–36 ), pulmonary artery measurement (six studies 12,17,22,28–30 ), RV size (two studies 22,30 ), vena cava size (three studies), 22,25,30 coronary sinus size (two studies), 22,30 and aortic valve dimensions (one study 30 ). Other individual parameters included reflux of contrast into the IVC (IVC reflux, four studies) 17,21,22,28 and interventricular septal deviation (five studies 17,21,22,28,33 ).…”

Section: Resultsmentioning

confidence: 99%

“…All echocardiography in included studies was transthoracic echocardiography. The individual measures used to assess RV dysfunction on CT scan were increased RV/LV ratio with varying cutoffs (24 studies [11][12][13][14][15][16][17][18][19][20][21][22][24][25][26][27][28][30][31][32][33][34][35][36] ), pulmonary artery measurement (six studies 12,17,22,[28][29][30] ), RV size (two studies 22,30 ), vena cava size (three studies), 22,25,30 coronary sinus size (two studies), 22,30 and aortic valve dimensions (one study 30 ).…”

Section: Study Characteristicsmentioning

confidence: 99%

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Detection of right ventricular dysfunction in acute pulmonary embolism by computed tomography or echocardiography: A systematic review and meta‐analysis

Chornenki

Poorzargar

Shanjer

et al. 2021

Journal of Thrombosis and Haemostasis

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Background Right ventricular (RV) dysfunction predicts worse outcomes in acute pulmonary embolism (PE). Because computed tomography (CT) pulmonary angiography visualizes cardiac structures, it is a potential method for assessing RV function without the delays associated with inpatient echocardiography. Objectives We conducted a systematic review and meta‐analysis to assess the diagnostic accuracy of CT scan findings for detecting RV dysfunction compared with echocardiography. Methods We searched MEDLINE and EMBASE from inception to April 2020 for studies comparing RV dysfunction on CT scan with echocardiography standard. Study quality was assessed with the QUADAS‐2 risk of bias tool. Meta‐analysis was performed using a bivariate mixed effects regression framework. Results After screening, 26 studies (3508 patients) were included. In a pooled analysis, septal deviation (5 studies; 459 patients) had a sensitivity of 0.31 (95% CI 0.25‐0.38; I2 = 0%), specificity of 0.98 (95% CI 0.90‐1.00; I2 = 59.4%), and positive likelihood ratio of 13.6 (95% CI 3.1‐60.4) for RV dysfunction compared with echocardiography. The pooled sensitivity of increased RV/left ventricular ratio (21 studies; 3111 patients) was 0.83 (95% CI 0.78‐0.87; I2 = 81.8%), whereas the pooled specificity was 0.75 (95% CI 0.66‐0.82; I2 = 94.2%) and negative likelihood ratio was 0.23 (0.18‐0.29). Conclusions Overall, RV dysfunction can be detected by CT imaging but the diagnostic accuracy when compared with echocardiography varies depending on specific findings. The presence of septal bowing appears to be highly specific for RV dysfunction. Our findings suggest that multiple CT findings of RV dysfunction may improve diagnostic accuracy and further studies are warranted.

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“…In previous studies these parameters were mainly analyzed: pulmonary artery/aorta ratio, right ventricular/left ventricular ratio, pulmonary obstruction index (POI), ventricular septal bowing (VSB) and venous contrast reflux (VCR) (ref. [12][13][14][15] ). In our study, we used pulmonary artery normalized diameter (nPA), PA/Ao ratio, RV CT/LV CT ratio in comparison with echocardiography parameters -normalized right ventricular diastolic diameter (nRV echo) and RV/LV diastolic diameter ratio (RVecho/LV echo).…”

Section: Introductionmentioning

confidence: 99%

Assessment of the severity of acute pulmonary embolism using CT pulmonary angiography parameters

et al. 2015

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Aim. To evaluate the association between computed tomography parameters and clinical signs in patients with acute pulmonary embolism. Methods. 109 patients retrospectivelly selected from hospital database with acute pulmonary embolism verified by CT pulmonary angiography. The following parameters were assessed: pulmonary artery diameter to aorta diameter ratio (PA/Ao), normalized pulmonary artery diameter (nPA), right ventricular to left ventricular diameter ratio from CT (RV CT/LV CT), normalized end-diastolic right ventricular diameter (nRVD echo) and right to left ventricular end diastolic diameter ratio (RV echo/LV echo) from echocardiography. Conclusion.From the CT pulmonary angiography parameters, the RV CT/LV CT showed a significant association with both thrombolysis administration and ICU hospitalization. The PA/Ao had relation only to thrombolytic therapy as well as RV echo/LV echo only to ICU hospitalization.

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Widening of coronary sinus in CT pulmonary angiography indicates right ventricular dysfunction in patients with acute pulmonary embolism

Abstract: Width of the coronary sinus seems to be a promising parameter for identification of RVD in patients with acute PE. A prospective study should be undertaken to further assess its clinical and prognostic applicability.

Cited by 9 publications

References 26 publications

Multidetector-CT angiography in pulmonary embolism—can image parameters predict clinical outcome?

Multidetector-CT angiography in pulmonary embolism—can image parameters predict clinical outcome?

Detection of right ventricular dysfunction in acute pulmonary embolism by computed tomography or echocardiography: A systematic review and meta‐analysis

Assessment of the severity of acute pulmonary embolism using CT pulmonary angiography parameters

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