Key result
An increased RV/LV dimension ratio on chest CT was a significant independent predictor of major adverse events within 30 days in patients with acute submassive pulmonary embolism (adjusted OR 7.96).
Why the study?
Does the RV/LV ratio on chest CT predict major adverse events in patients with hemodynamically stable acute submassive pulmonary embolism?
Observational (n=220)
No
Does the RV/LV ratio on chest CT predict major adverse events in patients with hemodynamically stable acute submassive pulmonary embolism?
An RV/LV ratio ≥ 1.3 on chest CT is a significant independent predictor of 30-day major adverse events in patients with hemodynamically stable acute submassive pulmonary embolism.
May refine 30-day risk stratification on routine CT in stable submassive PE; leaves open prospective validation for management decisions.
Background: The purpose of this study was to determine the prognostic significance of chest computed tomographic (CT) parameters in acute submassive pulmonary embolism (PE).Methods: Between January 2006 and December 2009, 268 consecutive patients with acute submassive PE that was confirmed by chest CT with pulmonary angiography in emergency room were studied.One experienced radiologist measured CT parameters and judged the presence of right ventricular dysfunction.CT parameters were analyzed to determine their ability to predict a major adverse event (MAE).Results: There were 220 patients included and 61 (27.7%) had MAE.Left ventricular and right ventricular maximum minor axis (36.4±8.0 vs. 41.7±7.4,p＜0.01; 45.7±9.4 vs. 41.5±7.6,p＜0.01), superior vena cava diameter (19.2±3.4 vs. 18.0±3.4,p=0.02), azygos vein diameter (10.0±2.2 vs. 9.2±2.3,p=0.02), septal displacement (19 vs. 18, p＜0.01) were significantly higher in MAE group than in no MAE group.Patients with MAE had high right ventricular/left ventricular dimension ratio (RV/LV ratio) compared to patients without MAE (1.34±0.48 vs. 1.03±0.28,p＜0.01).The most useful cut-off value of RV/LV ratio for MAE was 1.3 and the area under the curve was 0.71 (0.62∼0.79).Conclusion: RV/LV ratio on chest CT was a significant predictor of submassive PE related shock, intubation, in-hospital mortality, thrombolysis, thrombectomy within 30 days.
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Jung et al. (2010) conducted an observational in Acute submassive pulmonary embolism (n=220). RV/LV dimension ratio on chest CT vs. Lower RV/LV ratio was evaluated on Major adverse event (MAE) within 30 days (PE-related shock, intubation, in-hospital mortality, thrombolysis, thrombectomy) (OR 7.96, 95% CI 2.73-23.16, p=<0.01). An increased RV/LV dimension ratio on chest CT was a significant independent predictor of major adverse events within 30 days in patients with acute submassive pulmonary embolism (adjusted OR 7.96).
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