April 13, 2026Frontiers in PhysiologyOpen Access

Prognostic utility of combined 256-detector-row computed tomographic pulmonary angiography and D-dimer in risk stratification of acute pulmonary embolism: a retrospective cohort analysis

Q: What are the key findings of this study?

A combined model incorporating RVD/LVD ratio and D-dimer levels yielded an AUC of 0.917 for predicting high-risk acute pulmonary embolism, outperforming individual indicators.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute pulmonary embolism (APE) (n=166). Intervention: Combined 256-detector-row CTPA (RVD/LVD ratio) and D-dimer vs. Individual indicators (RVD/LVD or D-dimer alone). Primary outcome: Prediction of high-risk APE (AUC 0.917, 95% CI 0.852-0.983, p=<0.001).

Q: What question did this study set out to answer?

To assess the predictive value of 256-detector-row helical CTPA parameters combined with serum D-dimer levels for risk stratification and 30-day prognostic assessment in acute pulmonary embolism.

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Key result

Combining RVD/LVD ratio and D-dimer outperforms individual indicators for predicting high-risk APE with 0.92 AUC.

AUC 0.917
95% CI 0.852-0.983
P<0.001
n=166

Why the study?

The study assessed the predictive value of 256-detector-row CTPA parameters combined with serum D-dimer levels for risk stratification and 30-day prognostic assessment in acute pulmonary embolism.

Does the combination of CTPA-derived RVD/LVD ratio and D-dimer levels improve risk stratification and 30-day prognostic assessment in patients with acute pulmonary embolism?

Key Points

To assess the predictive value of 256-detector-row helical CTPA parameters combined with serum D-dimer levels for risk stratification and 30-day prognostic assessment in acute pulmonary embolism.
Retrospective cohort study analyzing 77 patients with APE across low-risk (n = 38), intermediate-low-risk (n = 17), intermediate-high-risk (n = 14), and high-risk (n = 8) groups, alongside 89 control individuals at Baoshan People’s Hospital between January 2021 and December 2024.
Evaluated CTPA-derived measurements (pulmonary artery-to-ascending aorta ratio, RVD/LVD ratio, superior vena cava diameter) and D-dimer concentrations using ROC curve analysis and multivariate logistic regression.
The combined model incorporating RVD/LVD and D-dimer yielded an AUC of 0.917 (95% CI: 0.852–0.983) for predicting high-risk APE, surpassing RVD/LVD alone (AUC = 0.874) and D-dimer alone (AUC = 0.716).
The RVD/LVD ratio positively correlated with risk stratification (ρ = 0.492; 95% CI: 0.30–0.64; p < 0.001; H = 26.093, p < 0.001), with median values of 0.99 in low-risk, 1.55 in intermediate-high-risk, and 1.52 in high-risk groups.
Multivariate logistic regression identified both RVD/LVD (OR = 124.605, p = 0.001) and D-dimer (OR = 1.313, p = 0.032) as independent predictors of poor short-term prognosis.

Study Design

Type

Cohort (n=166)

Blinding

Double-blind for imaging analysis

Multicenter

Structured PICO

Does the combination of CTPA-derived RVD/LVD ratio and D-dimer levels improve risk stratification and 30-day prognostic assessment in patients with acute pulmonary embolism?

Population

166 individuals, including 77 patients with acute pulmonary embolism (APE) (stratified into low-risk n=38, intermediate-low-risk n=17, intermediate-high-risk n=14, high-risk n=8) and 89 control individuals, treated at Baoshan People’s Hospital.

Intervention

Combined 256-detector-row computed tomographic pulmonary angiography (CTPA) parameters (specifically RVD/LVD ratio) and serum D-dimer levels

Comparator

Individual indicators (RVD/LVD alone or D-dimer alone)

Outcome

Risk stratification and 30-day prognostic assessment (predicting high-risk APE and poor short-term prognosis)surrogate

Main Result

Effect estimate: AUC 0.917 (95% CI 0.852-0.983)

Absolute Event Rate: 0.917% vs 0.874%

p-value: p=<0.001

The integration of CTPA-derived RVD/LVD ratio with D-dimer levels significantly improves risk stratification and short-term prognostic assessment in patients with acute pulmonary embolism.

Limitations

Single-center retrospective design
Limited sample size, especially in high-risk and poor-prognosis groups
Did not include other established biomarkers like troponin and BNP
Short-term follow-up of 30 days
Lack of external validation
single-center retrospective design
limited sample size

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

May improve acute PE risk stratification; extends evidence for combined RV/LV ratio and D-dimer but remains hypothesis-generating.

Cite This Study

Li et al. (2026) conducted a cohort in Acute pulmonary embolism (APE) (n=166). Combined 256-detector-row CTPA (RVD/LVD ratio) and D-dimer vs. Individual indicators (RVD/LVD or D-dimer alone) was evaluated on Prediction of high-risk APE (AUC 0.917, 95% CI 0.852-0.983, p=<0.001). A combined model incorporating RVD/LVD ratio and D-dimer levels yielded an AUC of 0.917 for predicting high-risk acute pulmonary embolism, outperforming individual indicators.

synapsesocial.com/papers/69dc874a3afacbeac03e9c56 https://doi.org/10.3389/fphys.2026.1796105

Topics

Pulmonary embolism

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Prognostic utility of combined 256-detector-row computed tomographic pulmonary angiography and D-dimer in risk stratification of acute pulmonary embolism: a retrospective cohort analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Topics

Prognostic utility of combined 256-detector-row computed tomographic pulmonary angiography and D-dimer in risk stratification of acute pulmonary embolism: a retrospective cohort analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider