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Evaluation of right ventricular dysfunction and prediction of clinical outcomes in acute pulmonary embolism by chest computed tomography: comparisons with echocardiography

  • Jeong Rang Park
  • Sung-A Chang
  • Shin Yi Jang
  • Hye Jin No
  • Sung-Ji Park
  • Seung-Hyuk Choi
  • Seung Woo Park
  • Hojoong Kim
  • Yeon Hyeon Choe
  • Kyung Soo Lee
  • Jae K. Oh
  • Duk-Kyung Kim
Original Paper

Abstract

To evaluate the ability to identify right ventricular (RV) dysfunction, and to predict adverse outcomes of chest computed tomography (CT), we compared CT and echocardiography in acute pulmonary embolism patients. We analyzed 56 patients diagnosed by CT with acute pulmonary embolism, who underwent echocardiography within 48 h of CT scan from January 2004 to December 2008. From the CT scan, the ratio of RV diameter to left ventricular diameter (RVd/LVd), the presence of septal bowing and embolus location were determined. RVd/LVd (P < 0.001), septal bowing (P < 0.001) and proximal embolism (P = 0.016) were associated with echocardiographic RV hypokinesia. The odds ratio for adverse clinical outcomes was 19.2 for the combination of three CT parameters (RVd/LVd > 1, septal bowing, and proximal embolism), and 13.4 for RV hypokinesia (each P = 0.001). The positive predictive value (PPV) for adverse clinical outcomes for echocardiographic RV hypokinesia was 55.0%, and the negative predictive value (NPV) was 96.2%. The three-parameter combination predicted adverse clinical outcomes with a PPV of 54.5%, and a NPV of 94.1%. CT parameters including RV dysfunction were significantly associated with poor outcomes. Rapid risk stratification of patients with acute pulmonary embolism based on chest CT appears to be comparable with echocardiography, is clinically reliable, and may be useful in guiding management strategy.

Keywords

Adverse clinical outcome Computed tomography Pulmonary embolism Right ventricular dysfunction Right ventricular hypokinesia 

Notes

Conflicts of interest

None.

References

  1. 1.
    Goldhaber SZ, Visani L, De Rosa M (1999) Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 353:1386–1389PubMedCrossRefGoogle Scholar
  2. 2.
    Goldhaber SZ, Elliott CG (2003) Acute pulmonary embolism: Part II: risk stratification, treatment, and prevention. Circulation 108:2834–2838PubMedCrossRefGoogle Scholar
  3. 3.
    Torbicki A, Perrier A, Konstantinides S et al (2008) Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 29:2276–2315PubMedCrossRefGoogle Scholar
  4. 4.
    Grifoni S, Olivotto I, Cecchini P et al (2000) Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation 101:2817–2822PubMedCrossRefGoogle Scholar
  5. 5.
    Kucher N, Rossi E, De Rosa M, Goldhaber SZ (2005) Prognostic role of echocardiography among patients with acute pulmonary embolism and a systolic arterial pressure of 90 mm Hg or higher. Arch Intern Med 165:1777–1781PubMedCrossRefGoogle Scholar
  6. 6.
    Schoepf UJ, Savino G, Lake DR, Ravenel JG, Costello P (2005) The age of CT pulmonary angiography. J Thorac Imaging 20:273–279PubMedCrossRefGoogle Scholar
  7. 7.
    Stein PD, Kayali F, Olson RE (2004) Trends in the use of diagnostic imaging in patients hospitalized with acute pulmonary embolism. Am J Cardiol 93:1316–1317PubMedCrossRefGoogle Scholar
  8. 8.
    He H, Stein MW, Zalta B, Haramati LB (2006) Computed tomography evaluation of right heart dysfunction in patients with acute pulmonary embolism. J Comput Assist Tomogr 30:262–266PubMedCrossRefGoogle Scholar
  9. 9.
    Schoepf UJ, Kucher N, Kipfmueller F, Quiroz R, Costello P, Goldhaber SZ (2004) Right ventricular enlargement on chest computed tomography: a predictor of early death in acute pulmonary embolism. Circulation 110:3276–3280PubMedCrossRefGoogle Scholar
  10. 10.
    Collomb D, Paramelle PJ, Calaque O et al (2003) Severity assessment of acute pulmonary embolism: evaluation using helical CT. Eur Radiol 13:1508–1514PubMedCrossRefGoogle Scholar
  11. 11.
    van der Meer RW, Pattynama PM, van Strijen MJ et al (2005) Right ventricular dysfunction and pulmonary obstruction index at helical CT: prediction of clinical outcome during 3 month follow-up in patients with acute pulmonary embolism. Radiology 235:798–803PubMedCrossRefGoogle Scholar
  12. 12.
    Mansencal N, Joseph T, Vieillard-Baron A et al (2005) Diagnosis of right ventricular dysfunction in acute pulmonary embolism using helical computed tomography. Am J Cardiol 95:1260–1263PubMedCrossRefGoogle Scholar
  13. 13.
    Quiroz R, Kucher N, Schoepf UJ et al (2004) Right ventricular enlargement on chest computed tomography: prognostic role in acute pulmonary embolism. Circulation 109:2401–2404PubMedCrossRefGoogle Scholar
  14. 14.
    Contractor S, Maldjian PD, Sharma VK, Gor DM (2002) Role of helical CT in detecting right ventricular dysfunction secondary to acute pulmonary embolism. J Comput Assist Tomogr 26:587–591PubMedCrossRefGoogle Scholar
  15. 15.
    Konstantinides S, Geibel A, Heusel G et al (2002) Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med 347:1143–1150PubMedCrossRefGoogle Scholar
  16. 16.
    Ghaye B, Ghuysen A, Willems V et al (2006) Severe pulmonary embolism: pulmonary artery clot load scores and cardiovascular parameters as predictors of mortality. Radiology 239:884–891PubMedCrossRefGoogle Scholar
  17. 17.
    Piazza G, Goldhaber SZ (2006) Acute pulmonary embolism: Part I: epidemiology and diagnosis. Circulation 114:e28–e32PubMedCrossRefGoogle Scholar
  18. 18.
    Kjaergaard J, Schaadt BK, Lund JO, Hassager C (2008) Quantification of right ventricular function in acute pulmonary embolism: relation to extent of pulmonary perfusion defects. Eur J Echocardiogr 9:641–645PubMedCrossRefGoogle Scholar
  19. 19.
    Kucher N, Wallmann D, Carone A, Windecker S, Meier B, Hess OM (2003) Incremental prognostic value of troponin I and echocardiography in patients with acute pulmonary embolism. Eur Heart J 24:1651–1656PubMedCrossRefGoogle Scholar
  20. 20.
    Murarka S, Movahed MR (2010) Review of Movahed’s sigh (D shaped left ventricle seen on gated SPECT) suggestive of right ventricular overload. Int J Cardiovasc Imaging 26:553–557PubMedCrossRefGoogle Scholar
  21. 21.
    Ascah KJ, King ME, Gillam LD, Weyman AE (1990) The effects of right ventricular hemodynamics on left ventricular configuration. Can J Cardiol 6:99–106PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2011

Authors and Affiliations

  • Jeong Rang Park
    • 1
    • 2
    • 6
  • Sung-A Chang
    • 1
    • 2
  • Shin Yi Jang
    • 2
  • Hye Jin No
    • 1
    • 2
  • Sung-Ji Park
    • 1
    • 2
  • Seung-Hyuk Choi
    • 1
    • 2
  • Seung Woo Park
    • 1
    • 2
  • Hojoong Kim
    • 3
  • Yeon Hyeon Choe
    • 2
    • 4
  • Kyung Soo Lee
    • 2
    • 4
  • Jae K. Oh
    • 1
    • 2
    • 5
  • Duk-Kyung Kim
    • 1
    • 2
  1. 1.Division of Cardiology, Department of MedicineSamsung Medical Center, Sungkyunkwan University School of MedicineSeoulRepublic of Korea
  2. 2.Cardiovascular Imaging Center, Cardiac and Vascular CenterSamsung Medical Center, Sungkyunkwan University School of MedicineSeoulRepublic of Korea
  3. 3.Division of Pulmonology and Critical Care Medicine Department of MedicineSamsung Medical Center, Sungkyunkwan University School of MedicineSeoulRepublic of Korea
  4. 4.Department of Radiology and Center for Imaging ScienceSamsung Medical Center, Sungkyunkwan University School of MedicineSeoulRepublic of Korea
  5. 5.Division of Cardiovascular DiseasesMayo Clinic College of MedicineRochesterUSA
  6. 6.Division of CardiologyDepartment of Internal Medicine, Gyeongsang National University HospitalJinjuRepublic of Korea

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