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Predictive value of reduced pulmonary arterial elasticity in acute pulmonary embolism for right ventricular dysfunction

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Abstract

Background: Computed tomography pulmonary angiography (CTPA) yields indices, such as the right ventricular/left ventricular (RV/LV) ratio > 1.0, which are commonly used for risk stratification of patients with acute pulmonary embolism (APE). Although pulmonary artery elasticity (PAE) has been previously described, its relationship with right ventricular dysfunction (RVD) has not been explored. Here, we investigated whether PAE, measured using CTPA, is associated with RVD. Methods: Patients who underwent retrospective electrocardiogram-gated CTPA and had a definitive diagnosis of APE were included in the study. The subjects were classified into RVD and non-RVD groups according to the RVD on echocardiography. PAE, involving aortic distensibility (AD), aortic compliance (AC), and aortic stiffness (ASI), and right heart function indices were compared between the two groups, and their correlations were examined. Receiver operating characteristic (ROC) curves were generated to evaluate the specificity and sensitivity of the RVD prediction. Results: Thirty-five patients with APE were enrolled in the study (RVD: 18, non-RVD: 17). The groups showed no significant differences in age, sex, number of patients receiving thrombolysis, and number of high-risk conditions (P > 0.05). Regarding PAE parameters, AD was significantly reduced in the RVD group compared to that in the non-RVD group (P < 0.05), whereas AC and ASI were not statistically different (P > 0.05). The ratio of the maximum cross-sectional area of PA and AA (PA/AAmax),the ratio of the minimum cross-sectional area of PA and AA(PA/AAmin), diameter of the coronary sinus, RV/LV diameter, RV/Lvarea, the ratio of the end-diastolic volume of right ventricular and left ventricular (RV/LVDV), the ratio of the end-systolic volume of right ventricular and left ventricular (RV/LVSV) were significantly greater in the RVD group than in the non-RVD group (P < 0.05). Correlation analysis of AD and right heart function parameters showed that AD was negatively correlated with PA/AAmax, PA/AAmin, RV/LV diameter, RV/LVDV, and PAE measured by ultrasound, with correlation coefficients ranging from − 0.336 to − 0.580 (P < 0.05). The ROC curves of AD and RV/LVdiameter to predict RVD had areas under the curve of 0.748 and 0.712, sensitivities of 82.35% and 70.59%, specificities of 66.67% and 72.22%, and cutoff values of 4.9433 and 1.1105, respectively. Conclusion: AD obtained by retrospective ECG-gated CTPA may be helpful in assessing RVD in patients with APE while accurately diagnosing APE. It contributes to timely diagnosis and treatment and improves the prognosis of patients with APE.

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Data Availability

The datasets used and/or analyzed in the current study are available from the corresponding author upon reasonable request.

References

  1. Anderson FA Jr, Spencer FA (2003) Risk factors for venous thromboembolism. Circulation 107(23 Suppl 1):I9–I16

    PubMed  Google Scholar 

  2. Aghayev A, Furlan A, Patil A et al (2013) The rate of resolution of clot burden measured by pulmonary CT angiography in patients with acute pulmonary embolism. AJR Am J Roentgenol 200:791–797

    Article  PubMed  PubMed Central  Google Scholar 

  3. Coutance G, Cauderlier E, Ehtisham J et al (2011) The prognostic value of markers of right ventricular dysfunction in pulmonary embolism: a meta-analysis. Crit Care 15(2):R103

    Article  PubMed  PubMed Central  Google Scholar 

  4. Abdelaal Ahmed Mahmoud M, Alkhatip A, Donnelly M, Snyman L et al (2020) YEARS algorithm versus Wells’ score: predictive accuracies in pulmonary embolism based on the gold standard CT pulmonary angiography. Crit Care Med 48(5):704–708

    Article  Google Scholar 

  5. Albrecht MH, Bickford MW, Nance JW Jr et al (2017) State-of-the-art pulmonary CT angiography for acute pulmonary embolism. AJR Am J Roentgenol 208(3):495–504

    Article  PubMed  Google Scholar 

  6. Konstantinides SV, Torbicki A, Agnelli G et al (2014) 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism (published correction appears in Eur Heart J). Eur Heart J 35(43):3033–69k

    Article  CAS  PubMed  Google Scholar 

  7. Konstantinides SV, Meyer G, Becattini C et al (2019) 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the european respiratory society (ERS): the Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J 54(3):1901647

    Article  PubMed  Google Scholar 

  8. Wu DK, Hsiao SH, Lin SK et al (2008) Main pulmonary arterial distensibility: different presentation between chronic pulmonary hypertension and acute pulmonary embolism. Circ J 72:1454–1459

    Article  PubMed  Google Scholar 

  9. Sanz J, Kariisa M, Dellegrottaglie S et al (2009) Evaluation of pulmonary artery stiffness in pulmonary hypertension with cardiac magnetic resonance. JACC Cardiovasc Imaging 2:286–295

    Article  PubMed  Google Scholar 

  10. Yang F, Wang D, Cui S et al (2021) Decreased pulmonary artery distensibility as a marker for severity in acute pulmonary embolism patients undergoing ECG-gated CTPA. J Thromb Thrombolysis 51(3):748–756 -4

    Article  PubMed  Google Scholar 

  11. Wu DK, Hsiao SH, Lin SK et al (2008) Main pulmonary arterial distensibility: different presentation between chronic pulmonary hypertension and acute pulmonary embolism. Circ J 72(9):1454–1459

    Article  PubMed  Google Scholar 

  12. Yang F, Wang D, Liu H et al (2018) Analysis of elasticity characteristics of ascending aorta, descending aorta and pulmonary artery using 640 slice-volume CT. Med (Baltim) 97(26):e11125

    Article  Google Scholar 

  13. Schmid J, Nagy E, Kaufmann-Bühler AK et al (2022) Diagnosing pulmonary embolism with computed tomography pulmonary angiography: diagnostic accuracy of a reduced scan range. J Thorac Imaging 37(5):323–330

    Article  PubMed  PubMed Central  Google Scholar 

  14. Castañer E, Gallardo X, Ballesteros E et al (2009) CT diagnosis of chronic pulmonary thromboembolism. Radiographics 29:31–50

    Article  PubMed  Google Scholar 

  15. Becattini C, Agnelli G, Lankeit M et al (2016) Acute pulmonary embolism: mortality prediction by the 2014 european Society of Cardiology risk stratification model. Eur Respir J 48(3):780–786

    Article  PubMed  Google Scholar 

  16. Jaff MR, McMurtry MS, Archer SL et al (2012) Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association [published correction appears in circulation. 126(7):e104

  17. Aviram G, Steinvil A, Berliner S et al (2011) The association between the embolic load and atrial size in acute pulmonary embolism. J Thromb Haemost 9(2):293–299

    Article  CAS  PubMed  Google Scholar 

  18. Liang W, Chen D, Chen W et al (2014) The ascending aortic elasticity feature in normotensive subjects: evaluation with coronary CT angiography. Clin Imaging 38(5):686–692

    Article  PubMed  Google Scholar 

  19. Wang W, Guo W, Liu XP et al (2015) Study of ascending aortic elasticity in the chinese population with a high risk of aortic diseases. Int J Clin Exp Med 8(3):3381–3390

    PubMed  PubMed Central  Google Scholar 

  20. Prosperi-Porta G, Ronksley P, Kiamanesh O et al (2022) Prognostic value of echocardiography-derived right ventricular dysfunction in haemodynamically stable pulmonary embolism: a systematic review and meta-analysis. Eur Respir Rev 31(166):220120

    Article  PubMed  PubMed Central  Google Scholar 

  21. Henzler T, Roeger S, Meyer M et al (2012) Pulmonary embolism: CT signs and cardiac biomarkers for predicting right ventricular dysfunction. Eur Respir J 39(4):919–926

    Article  CAS  PubMed  Google Scholar 

  22. Weekes AJ, Johnson AK, Troha D et al (2017) Prognostic value of right ventricular dysfunction markers for serious adverse events in Acute Normotensive Pulmonary Embolism. J Emerg Med 52(2):137–150

    Article  PubMed  Google Scholar 

  23. Dawes TJ, Gandhi A, de Marvao A et al (2016) Pulmonary artery stiffness is independently associated with right ventricular mass and function: a cardiac MR imaging study. Radiology 280(2):398–404

    Article  PubMed  Google Scholar 

  24. Swift AJ, Rajaram S, Condliffe R et al (2012) Pulmonary artery relative area change detects mild elevations in pulmonary vascular resistance and predicts adverse outcome in pulmonary hypertension. Invest Radiol 47(10):571–577

    Article  PubMed  Google Scholar 

  25. Jia CF, Jiang YN, Yang ZQ et al (2017) Ascending aortic elasticity and related risk factors study on prehypertension patients. Am J Hypertens 30(1):61–66

    Article  CAS  PubMed  Google Scholar 

  26. Li N, Beck T, Chen J et al (2011) Assessment of thoracic aortic elasticity: a preliminary study using electrocardiographically gated dual-source CT. Eur Radiol 21(7):1564–1572

    Article  PubMed  Google Scholar 

  27. Wong DT, Narayan O, Leong DP et al (2015) Regional aortic distensibility and its relationship with age and aortic stenosis: a computed tomography study. Int J Cardiovasc Imaging 31(5):1053–1062

    Article  PubMed  Google Scholar 

  28. Redheuil A, Wu CO, Kachenoura N et al (2014) Proximal aortic distensibility is an independent predictor of all-cause mortality and incident CV events: the MESA study. J Am Coll Cardiol 64(24):2619–2629

    Article  PubMed  PubMed Central  Google Scholar 

  29. Babes EE, Stoicescu M, Bungau SG et al (2022) Left ventricle outflow tract velocity-time index and right ventricle to left ventricle ratio as predictors for in hospital outcome in intermediate-risk pulmonary embolism. Diagnostics (Basel) 12(5):1226

    Article  CAS  PubMed  Google Scholar 

  30. Pruszczyk P, Goliszek S, Lichodziejewska B et al (2014) Prognostic value of echocardiography in normotensive patients with acute pulmonary embolism. JACC Cardiovasc Imaging 7(6):553–560

    Article  PubMed  Google Scholar 

  31. Meinel FG, Nance JW Jr, Schoepf UJ et al (2015) Predictive value of computed tomography in acute pulmonary embolism: systematic review and meta-analysis. Am J Med 128(7):747–59e2

    Article  PubMed  Google Scholar 

  32. Meyer G, Vicaut E, Danays T et al (2014) Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 370(15):1402–1411

    Article  CAS  PubMed  Google Scholar 

  33. Zhao DJ, Ma DQ, He W et al (2010) Cardiovascular parameters to assess the severity of acute pulmonary embolism with computed tomography. Acta Radiol 51(4):413–419

    Article  PubMed  Google Scholar 

  34. Jahanian S, Ayati A, Hosseini K et al (2022) Right-sided Electrocardiogram in patients with Acute Pulmonary Embolism. Crit Pathw Cardiol 21(1):24–29

    PubMed  Google Scholar 

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Acknowledgements

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Funding

This study was supported by grants from the Science and Technology Project of the Hebei Provincial Science and Technology Department (21377769D).

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Authors and Affiliations

  1. Department of Medical Imaging, the First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, 075000, China

    Fei Yang, Shujun Cui & Yongqing MA

  2. Hebei North University, Zhangjiakou, Hebei, 075000, China

    Rong Chen, Zhixiang Yang & Yue Yang

  3. Department of Thoracic Surgery, the First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, 075000, China

    Dawei Wang

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  1. Fei Yang
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Contributions

(I) Conception and design: YF and WDW; (II) Administrative support: CSJ; (III) Provision of study materials or patients: MYQ and WDW; (IV) Collection and assembly of data: CR and YY; (V) Data analysis and interpretation: YZX; (VI) Manuscript writing: All authors; (VII) Final approval of the manuscript: All authors.

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Correspondence to Dawei Wang.

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This study involving human participants was reviewed and approved by the Institutional Review Board of the First Affiliated Hospital of Hebei North University. Written informed consent for participation was not required for this study, in accordance with national legislation and institutional requirements.

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Yang, F., Chen, R., Yang, Z. et al. Predictive value of reduced pulmonary arterial elasticity in acute pulmonary embolism for right ventricular dysfunction. J Thromb Thrombolysis 56, 529–537 (2023). https://doi.org/10.1007/s11239-023-02873-z

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