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CT imaging determinants of persistent hypoxemia in acute intermediate-risk pulmonary embolism

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Abstract

The factors associated with persistent hypoxemia after pulmonary embolus (PE) are not well understood. Predicting the need for oxygen post discharge at the time of diagnosis using available CT imaging will enable better discharge planning. To examine the relationship between CT derived imaging markers (automated computation of arterial small vessel fraction, pulmonary artery diameter to aortic diameter ratio (PA:A), right to left ventricular diameter ratio (RV:LV) and new oxygen requirement at the time of discharge in patients diagnosed with acute intermediate-risk PE. CT measurements were obtained in a retrospective cohort of patients with acute-intermediate risk PE admitted to Brigham and Women’s Hospital between 2009 and 2017. Twenty one patients without a history of lung disease requiring home oxygen and 682 patients without discharge oxygen requirements were identified. There was an increased median PA:A ratio (0.98 vs. 0.92, p = 0.02) and arterial small vessel fraction (0.32 vs. 0.39, p = 0.001) in the oxygen-requiring group], but no difference in the median RV:LV ratio (1.20 vs. 1.20, p = 0.74). Being in the upper quantile for the arterial small vessel fraction was associated with decreased odds of oxygen requirement (OR 0.30 [0.10–0.78], p = 0.02). Loss of arterial small vessel volume as measured by arterial small vessel fraction and an increase in the PA:A ratio at the time of diagnosis were associated with the presence of persistent hypoxemia on discharge in acute intermediate-risk PE.

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Data availability

The data supporting the findings of this study, “CT imaging determinants of persistent hypoxemia in acute intermediate-risk pulmonary embolism,” are not publicly available due to privacy restrictions in accordance with the Health Insurance Portability and Accountability Act (HIPAA). The patient data used in this study were sourced from the MassGeneral Brigham Research Patient Data Registry (RPDR) system. Access to the RPDR system is granted only to authorized investigators affiliated with MassGeneral Brigham institutions who comply with its policies and procedures. Researchers interested in accessing the anonymized data for the purpose of replicating or validating the findings presented in this study may submit a request to the corresponding author, who will facilitate the data access process with the appropriate institutional review board (IRB) and the data custodians at MassGeneral Brigham. Please note that access to the data will be granted only to researchers who meet the criteria for access, and subject to the approval of their respective IRBs and adherence to data sharing agreements.

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Acknowledgements

Drs Hassan, Minhas, Rahaghi, Washko, Estépar, Piazza, Ash, Badlam, and Antkowiak were involved in conceptualization. Drs Minhas, Hassan, Nardelli, and Estépar were involved in data collection and analysis. All authors were involved in generation of the article and its approval. Drs Hassan and Rahaghi are guarantors of the paper and take responsibility for the integrity of the work as a whole.

Funding

This study was supported, in part, by a CHEST FOUNDATION GRANT for thromboembolism and in part by National Heart, Lung, and Blood Institute grants 1R01HL116931 (Drs Estépar and Washko), 1R01HL164717-01 (Dr Rahaghi), T32-HL-007891 (Dr Minhas). This study was approved by the IRB (No.2016P002693) at Brigham and Women’s Hospital (Boston, MA).

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Authors and Affiliations

  1. Division of Pulmonary Disease and Critical Care Medicine, University of Vermont, Burlington, VT, USA

    Syed Moin Hassan, MaryEllen C. Antkowiak & Jessica B. Badlam

  2. Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Pietro Nardelli, Rubén San José Estépar & Raúl San José Estépar

  3. Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, PA, USA

    Jasleen K. Minhas

  4. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Samuel Y. Ash, George R. Washko & Farbod N. Rahaghi

  5. Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Gregory Piazza

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  1. Syed Moin Hassan
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  2. Pietro Nardelli
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  11. Farbod N. Rahaghi
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Correspondence to Syed Moin Hassan.

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Hassan, S.M., Nardelli, P., Minhas, J.K. et al. CT imaging determinants of persistent hypoxemia in acute intermediate-risk pulmonary embolism. J Thromb Thrombolysis 56, 196–201 (2023). https://doi.org/10.1007/s11239-023-02813-x

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  • DOI: https://doi.org/10.1007/s11239-023-02813-x

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