TY - JOUR
T1 - CT signs of right ventricular dysfunction
T2 - Prognostic role in acute pulmonary embolism
AU - Kang, Doo Kyoung
AU - Thilo, Christian
AU - Schoepf, U. Joseph
AU - Barraza, J. Michael
AU - Nance, John W.
AU - Bastarrika, Gorka
AU - Abro, Joseph A.
AU - Ravenel, James G.
AU - Costello, Philip
AU - Goldhaber, Samuel Z.
N1 - Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2011/8
Y1 - 2011/8
N2 - Objectives: The purpose of this study was to compare the prognostic role of various computed tomography (CT) signs of right ventricular (RV) dysfunction, including 3-dimensional ventricular volume measurements, to predict adverse outcomes in patients with acute pulmonary embolism (PE). Background: Three-dimensional ventricular volume measurements based on chest CT have become feasible for routine clinical application; however, their prognostic role in patients with acute PE has not been assessed. Methods: We evaluated 260 patients with acute PE for the following CT signs of RV dysfunction obtained on routine chest CT: abnormal position of the interventricular septum, inferior vena cava contrast reflux, right ventricle diameter (RVD) to left ventricle diameter (LVD) ratio on axial sections and 4-chamber (4-CH) views, and 3-dimensional right ventricle volume (RVV) to left ventricle volume (LVV) ratio. Comorbidities and fatal and nonfatal adverse outcomes according to the MAPPET-3 (Management Strategies and Prognosis in Pulmonary Embolism Trial-3) criteria within 30 days were recorded. Results: Fifty-seven patients (21.9%) had adverse outcomes, including 20 patients (7.7%) who died within 30 days. An RVD axial/ LVD axial ratio >1.0 was not predictive for adverse outcomes. On multivariate analysis (adjusting for comorbidities), abnormal position of the interventricular septum (hazard ratio [HR]: 2.07; p = 0.007), inferior vena cava contrast reflux (HR: 2.57; p = 0.001), RVD 4-CH/LVD 4-CH ratio >1.0 (HR: 2.51; p = 0.009), and RVV/LVV ratio >1.2 (HR: 4.04; p < 0.001) were predictive of adverse outcomes, whereas RVD 4-CH/LVD 4-CH ratio >1.0 (HR: 3.68; p = 0.039) and RVV/LVV ratio >1.2 (HR: 6.49; p = 0.005) were predictive of 30-day death. Conclusions: Three-dimensional ventricular volume measurement on chest CT is a predictor of early death in patients with acute PE, independent of clinical risk factors and comorbidities. Abnormal position of the interventricular septum, inferior vena cava contrast reflux, and RVD 4-CH/LVD 4-CH ratio are predictive of adverse outcomes, whereas RVD axial/LVD axial ratio >1.0 is not.
AB - Objectives: The purpose of this study was to compare the prognostic role of various computed tomography (CT) signs of right ventricular (RV) dysfunction, including 3-dimensional ventricular volume measurements, to predict adverse outcomes in patients with acute pulmonary embolism (PE). Background: Three-dimensional ventricular volume measurements based on chest CT have become feasible for routine clinical application; however, their prognostic role in patients with acute PE has not been assessed. Methods: We evaluated 260 patients with acute PE for the following CT signs of RV dysfunction obtained on routine chest CT: abnormal position of the interventricular septum, inferior vena cava contrast reflux, right ventricle diameter (RVD) to left ventricle diameter (LVD) ratio on axial sections and 4-chamber (4-CH) views, and 3-dimensional right ventricle volume (RVV) to left ventricle volume (LVV) ratio. Comorbidities and fatal and nonfatal adverse outcomes according to the MAPPET-3 (Management Strategies and Prognosis in Pulmonary Embolism Trial-3) criteria within 30 days were recorded. Results: Fifty-seven patients (21.9%) had adverse outcomes, including 20 patients (7.7%) who died within 30 days. An RVD axial/ LVD axial ratio >1.0 was not predictive for adverse outcomes. On multivariate analysis (adjusting for comorbidities), abnormal position of the interventricular septum (hazard ratio [HR]: 2.07; p = 0.007), inferior vena cava contrast reflux (HR: 2.57; p = 0.001), RVD 4-CH/LVD 4-CH ratio >1.0 (HR: 2.51; p = 0.009), and RVV/LVV ratio >1.2 (HR: 4.04; p < 0.001) were predictive of adverse outcomes, whereas RVD 4-CH/LVD 4-CH ratio >1.0 (HR: 3.68; p = 0.039) and RVV/LVV ratio >1.2 (HR: 6.49; p = 0.005) were predictive of 30-day death. Conclusions: Three-dimensional ventricular volume measurement on chest CT is a predictor of early death in patients with acute PE, independent of clinical risk factors and comorbidities. Abnormal position of the interventricular septum, inferior vena cava contrast reflux, and RVD 4-CH/LVD 4-CH ratio are predictive of adverse outcomes, whereas RVD axial/LVD axial ratio >1.0 is not.
KW - cardiac volume
KW - computers
KW - diagnosis
KW - embolism
KW - prognosis
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U2 - 10.1016/j.jcmg.2011.04.013
DO - 10.1016/j.jcmg.2011.04.013
M3 - Article
C2 - 21835376
AN - SCOPUS:80051651891
VL - 4
SP - 841
EP - 849
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
SN - 1936-878X
IS - 8
ER -