Key result
In patients with acute pulmonary embolism, a CTPA clot burden score >18 was significantly associated with right ventricular dysfunction, including higher RV/LV ratio (P=0.001).
Why the study?
Does CTPA clot burden predict right ventricular dysfunction and mortality in patients with acute pulmonary embolism?
Observational (n=45)
Does CTPA clot burden predict right ventricular dysfunction and mortality in patients with acute pulmonary embolism?
p-value: p=0.001
In patients with acute pulmonary embolism, a CTPA clot burden score >18 is significantly associated with right ventricular dysfunction, providing a useful clinicoradiological tool for risk stratification.
May support CTPA clot burden scoring for RV dysfunction risk stratification in acute PE; leaves open prospective validation for outcomes.
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.
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El‐Menyar et al. (2016) conducted an observational in Acute pulmonary embolism (n=45). High CTPA clot burden (Qanadli score >18) vs. Lower CTPA clot burden was evaluated on Right ventricular dysfunction (p=0.001). In patients with acute pulmonary embolism, a CTPA clot burden score >18 was significantly associated with right ventricular dysfunction, including higher RV/LV ratio (P=0.001).
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