Key result
CTPA test bolus curve upslope time significantly predicted PE-related mortality (OR 1.65; P=0.05), offering prognostic value comparable to conventional right ventricular dysfunction metrics.
Why the study?
Does CTPA test bolus curve data predict PE-related mortality in patients with acute pulmonary embolism compared to conventional methods of RV dysfunction?
Cohort (n=71)
Single-blind
No
Does CTPA test bolus curve data predict PE-related mortality in patients with acute pulmonary embolism compared to conventional methods of RV dysfunction?
CTPA timing bolus curve data, specifically upslope and downslope times, provide prognostic value for predicting PE-related mortality comparable to conventional RV dysfunction metrics.
May aid PE mortality risk assessment with routine CTPA data; leaves open prospective validation against standard RV metrics.
PURPOSE: The purpose of the study was to evaluate the relationship between computed tomography pulmonary angiography (CTPA) test bolus curve data and mortality in patients with pulmonary embolism (PE) in comparison with conventional methods of right ventricular (RV) dysfunction. MATERIALS AND METHODS: The study was approved by our institutional review board and is HIPAA-compliant. We retrospectively evaluated consecutive CTPA studies performed with a test bolus technique in a 2-year period. A time-density curve was derived from each test bolus. For comparison, left ventricular (LV) and RV dimensions (area, diameter) and PE load score (Qanadli method) were measured using CT data. A cardiologist blinded to the clinical and other imaging data reviewed a subset of the corresponding echocardiographic images to assess for RV dysfunction. Demographic data, mode of treatment, and patient outcome information were gathered using electronic medical records. Test bolus and anatomic data were correlated with PE-related mortality. RESULTS: A total of 71 patients (34 men and 37 women, average age 54.4 y) who had a CTPA performed using a test bolus technique were diagnosed with acute PE. Factors that significantly correlated with PE-related mortality on univariate analysis were: age above 60 years (odds ratio 19.1, P = 0.05), RV/LV diameter >1.5 (odds ratio 48.8, P < 0.001), RV/LV area >1 (odds ratio 8.6, P = 0.06), bolus curve upslope time >6 seconds (odds ratio 23.3, P = 0.04), 50% downslope time >6 seconds (odds ratio 20, P = 0.01), and embolus load score >15 (odds ratio 25, P = 0.03). The predictive value of upslope time (Exp(B) 1.65, P = 0.05), RV/LV diameter (Exp(B) 43.8, P = 0.01), and RV/LV area (Exp(B) 16.7, P = 0.01) were confirmed to be statistically significant in multivariate analyses. CONCLUSIONS: Data from the CTPA timing bolus curve provide prognostic value similar to the best conventional methods for predicting PE-related mortality.
No takes yet. Share an insight, caveat, or question.
Li et al. (2015) conducted a cohort in Acute pulmonary embolism (n=71). CTPA test bolus curve upslope time vs. Normal upslope time was evaluated on PE-related mortality (OR 1.65, p=0.05). CTPA test bolus curve upslope time significantly predicted PE-related mortality (OR 1.65; P=0.05), offering prognostic value comparable to conventional right ventricular dysfunction metrics.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: