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The efficacy of CT for detection of right ventricular dysfunction in acute pulmonary embolism, and comparison with cardiac biomarkers

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Abstract

Purpose

The purpose of this study was to evaluate results from computed tomography pulmonary angiography (CTPA) indicative of right ventricular dysfunction (RVD), and to assess the relationship of these results with cardiac biomarkers and mortality among patients with acute PE.

Materials and methods

This retrospective study involved 118 patients with acute PE proved by CTPA. CTPA variables were analyzed and compared with cardiac biomarkers and echocardiography (ECHO) findings.

Results

Compared with ECHO, the sensitivity, specificity, positive predictive value, and negative predictive value of CTPA for detection of RVD were 85.7, 91.7, 93.7, and 81.5 %, respectively. ROC curve analysis for prediction of RVD resulted in areas under the curve of 0.925 for RV dimension (95 % CI 0.879−0.971, p < 0.001) and 0.913 for main pulmonary artery (MPA) diameter (95 % CI 0.863−0.963, p < 0.001). The optimum cut-off values for prediction of RVD were 37.5 mm for RV dimension and 29.1 mm for MPA diameter. These values were also statistically significantly greater for non-survivors than for survivors (p = 0.001, p < 0.001, respectively) and significantly associated with cardiac biomarkers.

Conclusion

It was found that CTPA findings were significantly associated with the presence of RVD in ECHO, cardiac biomarkers, and mortality of patients with acute PE.

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References

  1. Burns SK, Haramati LB. Diagnostic imaging and risk stratification of patients with acute pulmonary embolism. Cardiol Rev. 2012;20:15–24.

    Article  PubMed  Google Scholar 

  2. Goldhaber SZ. Venous thromboembolism: epidemiology and magnitude of the problem. Best Pract Res Clin Haematol. 2012;25:235–42.

    Article  PubMed  Google Scholar 

  3. Remy-Jardin M, Pistolesi M, Goodman LR, et al. Management of suspected acute pulmonary embolism in the era of CT angiography: a statement from the Fleischner Society. Radiology. 2007;245:315–29.

    Article  PubMed  Google Scholar 

  4. Henzler T, Barraza JM Jr, Nance JW Jr, et al. CT imaging of acute pulmonary embolism. J Cardiovasc Comput Tomogr. 2011;5:3–11.

    Article  PubMed  Google Scholar 

  5. Sanchez O, Trinquart L, Colombet I, et al. Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: a systematic review. Eur Heart J. 2008;29:1569–77.

    Article  PubMed  Google Scholar 

  6. Kang DK, Thilo C, Schoepf UJ, Barraza JM Jr, Nance JW Jr, Bastarrika G, et al. CT sings of right ventricular dysfunction; prognostic role in acute pulmonary embolism. JACC Cardiovasc Imaging. 2011;4:841–9.

    Article  PubMed  Google Scholar 

  7. Trujillo-Santos J, den Exter PL, Gómez V, Del Castillo H, Moreno C, van der Hulle T, Huisman MV, et al. Computed tomography-assessed right ventricular dysfunction and risk stratification of patients with acute non-massive pulmonary embolism: systematic review and meta-analysis. J Thromb Haemost. 2013;11:1823–32.

    CAS  PubMed  Google Scholar 

  8. Lega JC, Lacasse Y, Lakhal L, Provencher S. Natriuretic peptides and troponins in pulmonary embolism: a meta-analysis. Thorax. 2009;64:869–75.

    Article  PubMed  Google Scholar 

  9. Golpe R, Pe´rez-de-Llano LA, Castro-Anon O, et al. Right ventricle dysfunction and pulmonary hypertension in hemodynamically stable pulmonary embolism. Respir Med. 2010;104:1370–6.

    Article  PubMed  Google Scholar 

  10. Wittram C, Maher MM, Yoo AJ, Kalra MK, Shepard JO, McLoud TC. CT angiography of pulmonary embolism: diagnostic criteria and causes of misdiagnosis. Radiographics. 2004;24:1219–39.

    Article  PubMed  Google Scholar 

  11. Grifoni S, Olivotto I, Cecchini P, Pieralli F, Camaiti A, Santoro G, et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation. 2000;101:2817–22.

    Article  CAS  PubMed  Google Scholar 

  12. Ribeiro A, Lindmarker P, Juhlin-Dannfelt A, et al. Echocardiography doppler in pulmonary embolism: right ventricular dysfunction as a predictor of mortality. Am Heart J. 1997;134:479–87.

    Article  CAS  PubMed  Google Scholar 

  13. Lim KE, Chan CY, Chu PH, et al. Right ventricular dysfunction secondary to acute massive pulmonary embolism detected by helical computed tomography pulmonary angiography. Clin Imaging. 2005;29:16–21.

    Article  PubMed  Google Scholar 

  14. Jimenez D, Aujesky D, Yusen RD. Risk stratification of normotensive patients with acute symptomatic pulmonary embolism. Br J Haematol. 2010;151:415–24.

    Article  PubMed  Google Scholar 

  15. Sakuma M, Konno Y, Shirato K. Increasing mortality from pulmonary embolism in Japan, 1951–2000. Circ J. 2002;66:1144–9.

    Article  PubMed  Google Scholar 

  16. Goldhaber SZ. Advanced treatment strategies for acute pulmonary embolism, including thrombolysis and embolectomy. J Thromb Haemost. 2009;7:322–7.

    Article  PubMed  Google Scholar 

  17. Kreit JW. The impact of right ventricular dysfunction on the prognosis and therapy of normotensive patients with pulmonary embolism. Chest. 2004;125:1539–45.

    Article  PubMed  Google Scholar 

  18. Goldhaber SZ. Echocardiography in the management of pulmonary embolism. Ann Intern Med. 2002;136:691–700.

    Article  PubMed  Google Scholar 

  19. Contractor S, Maldjian PD, Sharma VK, Gor DV. Role of Helical CT in detecting right ventricular dysfunction secondary to acute pulmonary embolism. J Comput Assist Tomogr. 2006;4:587–91.

    Google Scholar 

  20. Ozsu S, Karaman K, Mentese A, et al. Combined risk stratification with computerized tomography/echocardiography and biomarkers in patients with normotensive pulmonary embolism. Thromb Res. 2010;126:486–92.

    Article  CAS  PubMed  Google Scholar 

  21. Apfaltrer P, Henzler T, Meyer M, et al. Correlation of CT angiographic pulmonary artery obstruction scores with right ventricular dysfunction and clinical outcome in patients with acute pulmonary embolism. Eur J Radiol. 2012;81:2867–71.

    Article  CAS  PubMed  Google Scholar 

  22. Park JR, Chang SA, Jang SY, et al. Evaluation of right ventricular dysfunction and prediction of clinical outcomes in acute pulmonary embolism by chest computed tomography: comparisons with echocardiography. Int J Cardiovasc Imaging. 2012;28:979–87.

    Article  PubMed  Google Scholar 

  23. Henzler T, Roeger S, Meyer M, et al. Pulmonary embolism: CT signs and cardiac biomarkers for predicting right ventricular dysfunction. Eur Respir J. 2012;39:919–26.

    Article  CAS  PubMed  Google Scholar 

  24. Cok G, Tasbakan MS, Ceylan N, Bayraktaroglu S, Duman S. Can we use CT pulmonary angiography as an alternative to echocardiography in determining right ventricular dysfunction and its severity in patients with acute pulmonary thromboembolism? Jpn J Radiol. 2013;31:172–8.

    Article  PubMed  Google Scholar 

  25. Aribas A, Keskin S, Akilli H, Kayrak M, Erdogan HI, Guler I, et al. The use of axial diameters and CT obstruction scores for determining echocardiographic right ventricular dysfunction in patients with acute pulmonary embolism. Jpn J Radiol. 2014;32:451–60.

    Article  PubMed  Google Scholar 

  26. Vuilleumier N, Verschuren F, Perrier A, Bounameaux H, Turck N, Sanchez JC, et al. Cardiac biomarkers for risk stratification in nonmassive pulmonary embolism: a multicenter prospective study. J Thromb Haemost. 2009;7:391–8.

    Article  CAS  PubMed  Google Scholar 

  27. Seon HJ, Kim KH, Lee WS, Choi S, Yoon HJ, Ahn Y, et al. Usefulness of computed tomographic pulmonary angiography in the risk stratification of acute pulmonary thromboembolism. Circ J. 2011;75:428–36.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declared no potential conflict of interests with regard to the research, authorship, and/or publication of this paper.

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Authors and Affiliations

  1. Department of Chest Diseases, Faculty of Medicine, Firat University, 23119, Elazig, Turkey

    Erdal İn

  2. Department of Radiology, Faculty of Medicine, Firat University, Elazıg, Turkey

    Ayşe Murat Aydın

  3. Department of Cardiology, Faculty of Medicine, Firat University, Elazıg, Turkey

    Mustafa Necati Dağlı

  4. Yedikule Teaching Hospital for Pulmonology and Thoracic Surgery, Istanbul, Turkey

    Cengiz Özdemir & Sinem Nedime Sökücü

Authors
  1. Erdal İn
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  2. Ayşe Murat Aydın
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  3. Cengiz Özdemir
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  4. Sinem Nedime Sökücü
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  5. Mustafa Necati Dağlı
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Correspondence to Erdal İn.

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İn, E., Aydın, A.M., Özdemir, C. et al. The efficacy of CT for detection of right ventricular dysfunction in acute pulmonary embolism, and comparison with cardiac biomarkers. Jpn J Radiol 33, 471–478 (2015). https://doi.org/10.1007/s11604-015-0447-9

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  • DOI: https://doi.org/10.1007/s11604-015-0447-9

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