Computed Tomography Angiography overestimated the RV/LV ratio by an average of 0.32 compared to Transthoracic Echocardiography (p>0.0001), with a PPV of 0.44 for detecting submassive PE.
Observational (n=201)
No
Does measurement of RV/LV ratio by Computed Tomography Angiography accurately detect submassive pulmonary embolism compared to Transthoracic Echocardiography in patients with suspected pulmonary embolism?
CTA significantly overestimates the RV/LV ratio compared to TTE, highlighting the need for synergistic use of both modalities rather than relying solely on CTA to guide intervention for submassive pulmonary embolism.
Effect estimate: PPV 0.44, NPV 0.9
p-value: p=>0.0001
OBJECTIVES: Early intervention in submassive pulmonary embolism (SMPE) has been shown to improve long-term cardiopulmonary outcomes compared to anticoagulation alone. SMPEs are diagnosed by documentation of right-to-left ventricular (RV/LV) ratio > 0.9, indicative of right heart strain (RHS), and is associated with adverse clinical outcomes. Although often used interchangeably to guide treatment of SMPE, limited data exists comparing measurement of RV/LV ratio by Computed Tomography Angiography (CTA) and Transthoracic Echocardiography (TTE). We also examined the role of Artificial Intelligence (AI) in early detection of SMPE. METHODS: A single-institution retrospective review of AI-detected pulmonary embolism (Viz.ai) on CTA chest was performed over one year. Detection of PE on CTA by AI (CTA/AI) activated the pulmonary embolism response team (PERT). SMPE was defined by RV/LV ratio of >0.9. A TTE was performed in all patients with SMPE on CTA confirmed by radiology (CTA/RAD). In addition, some patients had TTE based on their clinical condition despite RV/LV 0.0001) higher than on CTA/RAD. When compared to CTA/RAD, CTA/AI had a PPV of 0.6 for detection of any PE. Using TTE as the standard, CTA/RAD had a PPV of 0.44, NPV of 0.9 for detection of SMPE. CONCLUSIONS: Our study suggests the need for further improvements in CTA/AI PE detection and that CTA/RAD is suboptimal in the evaluation of SMPE in isolation. We also noted that CTA/RAD significantly overestimates the RV/LV ratio and thereby RHS compared to TTE. Basing the need for intervention solely on CTA/RAD may subject patients unnecessarily to the risks associated with intervention for SMPE. Our data suggests the importance of including both CTA and TTE in the PERT algorithm, and that these imaging modalities should not be used interchangeably, but synergistically to guide treatment for SMPE.
Wi et al. (Fri,) conducted a observational in Submassive pulmonary embolism (n=201). Computed Tomography Angiography (CTA) vs. Transthoracic Echocardiography (TTE) was evaluated on Detection of submassive pulmonary embolism (RV/LV ratio > 0.9) (PPV 0.44, NPV 0.9, p=>0.0001). Computed Tomography Angiography overestimated the RV/LV ratio by an average of 0.32 compared to Transthoracic Echocardiography (p>0.0001), with a PPV of 0.44 for detecting submassive PE.