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Value of CT pulmonary angiography to predict short-term outcome in patient with pulmonary embolism

  • Ahmed M. Osman
  • Emad H. Abdeldayem
Original Paper

Abstract

To evaluate the role of CT pulmonary angiography (CTPA) in the assessment of pulmonary embolism (PE) severity and the related CT cardiac changes, reflecting the clinical status of the patients and predicting the outcome. A prospective study of 184 patients presented with suspicious acute PE. All patients underwent CTPA followed by ECHO. Pulmonary artery obstructive index (PAOI) using Qanadli Score was calculated and cardiac changes recorded. The patients’ outcome was followed up for 30 days. Only 150 patients completed the study; 26.7% needed ICU admission while 13.3% died during follow-up. There was a significant relationship between the PAOI and the risk classification, right ventricular dysfunction (RVD) diagnosed by ECHO and the patients’ short outcome. We found PAOI cut off value 45% for mortality and 35% for ICU admission and 27.5% for RVD with 60, 75 and 90% sensitivity and 80, 73.3 and 68.6% specificity respectively. CT RV/LV ratio was the most sensitive parameter to predict RV dysfunction followed by pulmonary artery diameter. CTPA is not only used for diagnosis but also to assess the severity of PE, the effect on the right ventricular function and subsequently the need for ICU admission and prediction of the outcome.

Keywords

Computed tomography angiography Pulmonary embolism Echocardiography Right ventricular dysfunction Patient outcome assessment Qanadli score 

Notes

Compliance with ethical standards

Conflict of interest

Authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of our institutional review board with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Goubran HA, Sholkamy S, Haddad A et al (2012) Venous thromboembolism risk and prophylaxis in the acute hospital care setting: report from the ENDORSE study in Egypt. Thromb J 10:20CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Oger E (2000) Incidence of venous thromboembolism in a community-based study in western France. Thromb Haemost 83:657–660CrossRefPubMedGoogle Scholar
  3. 3.
    Belohlavek J, Dytrych V, Linhart A (2013) Pulmonary embolism part I: epidemiology, risk factors, risk stratification, pathophysiology, clinical presentation, diagnosis and non thrombotic pulmonary embolism. Exp Clin Cardiol 18(2):129–138PubMedPubMedCentralGoogle Scholar
  4. 4.
    Kasper W, Konstantinides S, Geibel A et al (1997) Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol 30(5):1165–1171CrossRefPubMedGoogle Scholar
  5. 5.
    Wood KE (2002) Major pulmonary embolism: review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism. Chest 121(3):877–905CrossRefPubMedGoogle Scholar
  6. 6.
    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(18):2276–2315CrossRefPubMedGoogle Scholar
  7. 7.
    Masotti L, Righini M, Vuilleumier N et al (2009) Prognostic stratification of acute pulmonary embolism: focus on clinical aspects, imaging, and biomarkers. Vasc Health Risk Manage 5:567–575CrossRefGoogle Scholar
  8. 8.
    Goldhaber SZ, Visani L, De Rosa M (1999) Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 353(9162):1386–1389CrossRefPubMedGoogle Scholar
  9. 9.
    Apfaltrer P, Henzler T, Meyer M et al (2012) Correlation of CT angiographic pulmonary artery obstruction scores with right ventricular dysfunction and clinical outcome in patients with acute pulmonary embolism. Eur J Radiol 81(10):2867–2871CrossRefPubMedGoogle Scholar
  10. 10.
    Baile EM, King GG, Muller NL et al (2000) Spiral computed tomography is comparable to angiography for the diagnosis of pulmonary embolism. Am J Respir Crit Care Med 161:1010–1015CrossRefPubMedGoogle Scholar
  11. 11.
    Remy-Jardin M, Remy J, Baghaie F et al (2000) Clinical value of thin-collimation CT in the diagnostic workup of pulmonary embolism. Am J Roentgenol 175:407–411CrossRefGoogle Scholar
  12. 12.
    Ghaye B, Szapiro D, Mastora I et al (2001) Peripheral pulmonary arteries: how far in the lung does multidetector- row spiral CT allow analysis? Radiology 219:629–636CrossRefPubMedGoogle Scholar
  13. 13.
    Park JR, Chang SA, Jang SY et al (2012) 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 28(4):979–987CrossRefPubMedGoogle Scholar
  14. 14.
    Qanadli SD, El Hajjam M, Vieillard-Baron A et al (2001) New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography. Am J Roentgenol 176(6):1415–1420CrossRefGoogle Scholar
  15. 15.
    Hefeda MM, Elmasry MM (2014) Prediction of short term outcome of pulmonary embolism: parameters at 16 multi‑detector CT pulmonary angiography. Egypt J Radiol Nucl Med 45:1089‑98Google Scholar
  16. 16.
    Aviram G, Rogowski O, Gotler Y et al (2008) Real‑time risk stratification of patients with acute pulmonary embolism by grading the reflux of contrast into the inferior vena cava on computerized tomographic pulmonary angiography. J Thromb Haemost 6:1488‑93CrossRefGoogle Scholar
  17. 17.
    El-Menyar A, Nabir S, Ahmed N et al (2016) Diagnostic implications of computed tomography pulmonary angiography in patients with pulmonary embolism. Ann Thorac Med 11:269–276CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Kreit JW (2004) The impact of right ventricular dysfunction on the prognosis and therapy of normotensive patients with pulmonary embolism. Chest 125(4):1539–1545CrossRefPubMedGoogle Scholar
  19. 19.
    Ghaye B, Ghuysen A, Bruyere PJ et al (2006) Can CT pulmonary angiography allow assessment of severity and prognosis in patients presenting with pulmonary embolism? What the radiologist needs to know. Radiographics 26:23–39CrossRefPubMedGoogle Scholar
  20. 20.
    Mastora I, Remy-Jardin M, Masson P et al (2003) Severity of acute pulmonary embolism: evaluation of a new spiral CT angiographic score in correlation with echocardiographic data. Eur Radiol 13:29–35CrossRefPubMedGoogle Scholar
  21. 21.
    Vedovati MC, Germini F, Agnelli G et al (2013) Prognostic role of embolic burden assessed at computed-tomography angiography in patients with acute pulmonary embolism: systematic review and meta-analysis. J Thromb Haemost 11:2092–2102CrossRefPubMedGoogle Scholar
  22. 22.
    Selimoglu H, Abakay O, Cetincakmak M et al (2014) A single imaging modality in the diagnosis, severity and prognosis of pulmonary embolism. BioMed Res Int 470295:10Google Scholar
  23. 23.
    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(3):798–803CrossRefPubMedGoogle Scholar
  24. 24.
    Bazeed MF, Saad A, Sultan A et al (2010) Prediction of pulmonary embolism outcome and severity by computed tomography. Acta Radiol 51:271‑6CrossRefGoogle Scholar
  25. 25.
    Collomb D, Paramelle PJ, Calaque O et al (2003) Severity assessment of acute pulmonary embolism: evaluation using helical CT. Eur Radiol 13:1508–1514CrossRefPubMedGoogle Scholar
  26. 26.
    Wu AS, Pezzullo JA, Cronan JJ et al (2004) CT pulmonary angiography: quantification of pulmonary embolus as a predictor of patient outcome—initial experience. Radiology 230:831–835CrossRefPubMedGoogle Scholar
  27. 27.
    Contractor S, Maldjian PD, Sharma VK et al (2002) Role of helical CT in detecting right ventricular dysfunction secondary to acute pulmonary embolism. J Comput Assist Tomogr 26:587–591CrossRefPubMedGoogle Scholar
  28. 28.
    Lim KE, Chan CY, Chu PH et al (2005) Right ventricular dysfunction secondary to acute massive pulmonary embolism detected by helical computed tomography pulmonary angiography. Clin Imaging 29:16–21CrossRefPubMedGoogle Scholar
  29. 29.
    Attia MN, Seifeldein GS, Hasan AA et al (2015) Evaluation of acute pulmonary embolism by sixty‑four slice multidetector CT angiography: correlation between obstruction index, right ventricular dysfunction and clinical presentation. Egypt J Radiol Nucl Med 46:25‑32Google Scholar
  30. 30.
    Araoz PA, Gotway MB, Trowbridge RL et al (2003) Helical CT pulmonary angiography predictors of in-hospital morbidity and mortality in patients with acute pulmonary embolism. J Thorac Imaging 18:207–216CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Radiology Department, Faculty of MedicineAin Shams UniversityCairoEgypt

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