Evaluation of Predictive Value of CT Pulmonary Angiography for Right Ventricular Failure in Patients with Pulmonary Embolism
Abstract
Purpose: Right ventricle failure is a well-known complication following pulmonary thromboembolism. Although Computed Tomography Pulmonary Angiography (CTPA) findings are supposed to be a surrogate for patients’ outcome, investigations based on this issue is not still elucidated. Thus, in the current study, we assessed patients’ CTPA findings and compared the result with echocardiographic findings.
Materials and Methods: A total of 36 patients with proven pulmonary thromboembolism were enrolled and a comparison was made between indices in CTPA (interventricular septal deviation to the right side, inferior vena cava contrast reflux, and right ventricle diameter to left ventricle diameter ratio) and echocardiographic findings for detecting right ventricular failure. Also, the reliability of the aforementioned indices was sought for predicting mortality.
Results: No significant correlation was found between CTPA indices and echocardiographic findings. The highest sensitivity and positive predictive value in CT pulmonary angiography for detecting right ventricle dysfunction were revealed to be for Right Ventricle Diameter (RVD)/Left Ventricle Diameter (LVD)>1 (63.64%), abnormal septal deviation (75.00%), respectively.
Conclusion: Our results revealed that CTPA indices can reliably predict the upcoming mortality risk. On the other hand, these indices were not well-correlated with echocardiographic findings.
2- C. R. Martinez Licha, C. M. McCurdy, S. M. Maldonado, and L. S. Lee, "Current Management of Acute Pulmonary Embolism." (in eng), Ann Thorac Cardiovasc Surg, Vol. 26 (No. 2), pp. 65-71, Apr 20 (2020).
3- B. Mabrouk et al., "[Pulmonary thromboembolism: incidence, physiopathology, diagnosis and treatment]." (in fre), Tunis Med, Vol. 92 (No. 7), pp. 435-47, Jul (2014). L'embolie pulmonaire fibrino-cruorique fréquence, physiopathologie, tableau Clinique et traitement.
4- J. A. Watts, M. R. Marchick, and J. A. Kline, "Right ventricular heart failure from pulmonary embolism: key distinctions from chronic pulmonary hypertension." (in eng), J Card Fail, Vol. 16 (No. 3), pp. 250-9, Mar (2010).
5- S. Z. Goldhaber, "Venous Thromboembolism in Heart Failure Patients: Pathophysiology, Predictability, Prevention." (in eng), J Am Coll Cardiol, Vol. 75 (No. 2), pp. 159-62, Jan 21 (2020).
6- S. E. Crager and C. Humphreys, "Right Ventricular Failure and Pulmonary Hypertension." (in eng), Emerg Med Clin North Am, Vol. 40 (No. 3), pp. 519-37, Aug (2022).
7- R. Voswinckel, M. M. Hoeper, T. Kramm, and H. A. Ghofrani, "[Right heart failure in chronic pulmonary hypertension and acute pulmonary embolism]." (in ger), Internist (Berl), Vol. 53 (No. 5), pp. 545-56, May (2012). Rechtsherzversagen bei chronischer pulmonaler Hypertonie und akuter Lungenembolie.
8- P. M. Roy et al., "Appropriateness of diagnostic management and outcomes of suspected pulmonary embolism." (in eng), Ann Intern Med, Vol. 144 (No. 3), pp. 157-64, Feb 7 (2006).
9- R. Goggs, L. Benigni, V. L. Fuentes, and D. L. Chan, "Pulmonary thromboembolism." (in eng), J Vet Emerg Crit Care (San Antonio), Vol. 19 (No. 1), pp. 30-52, Feb (2009).
10- H. New and C. G. Byers, "Pulmonary thromboembolism." (in eng), Compend Contin Educ Vet, Vol. 33 (No. 9), p. E1, Sep (2011).
11- V. Palm, F. Rengier, P. Rajiah, C. P. Heussel, and S. Partovi, "Acute Pulmonary Embolism: Imaging Techniques, Findings, Endovascular Treatment and Differential Diagnoses." (in eng), Rofo, Vol. 192 (No. 1), pp. 38-49, Jan (2020). Akute Lungenarterienembolie: Bildgebung, Bildbefunde, endovaskuläre Therapie und Differenzialdiagnosen.
12- M. Righini and H. Robert-Ebadi, "Diagnosis of acute Pulmonary Embolism." (in eng), Hamostaseologie, Vol. 38 (No. 1), pp. 11-21, Feb (2018). Diagnose der akuten Lungenembolie.
13- S. Alerhand, T. Sundaram, and M. Gottlieb, "What are the echocardiographic findings of acute right ventricular strain that suggest pulmonary embolism?" (in eng), Anaesth Crit Care Pain Med, Vol. 40 (No. 2), p. 100852, Apr (2021).
14- G. Zantonelli et al., "Acute Pulmonary Embolism: Prognostic Role of Computed Tomography Pulmonary Angiography (CTPA)." (in eng), Tomography, Vol. 8 (No. 1), pp. 529-39, Feb 14 (2022).
15- Reza Javadrashid et al., "Correlation between Findings of CT Pulmonary Angiography and Outcome of Diseases in Patients with Acute Pulmonary Embolism." Med J Tabriz Uni Med Sciences Health Services, Vol. 38 (No. 5), pp. 6-11, 2016/12/5 (2016).
16- D. K. Kang et al., "CT signs of right ventricular dysfunction: prognostic role in acute pulmonary embolism." (in eng), JACC Cardiovasc Imaging, Vol. 4 (No. 8), pp. 841-9, Aug (2011).
17- J. H. Reid and J. T. Murchison, "Acute right ventricular dilatation: a new helical CT sign of massive pulmonary embolism." (in eng), Clin Radiol, Vol. 53 (No. 9), pp. 694-8, Sep (1998).
18- Jianguo Wang et al., "The dynamic study of the pulmonary artery obstruction degree and the right ventricular function in massive pulmonary embolism on CT pulmonary angiography⋆ ⋆This work was supported by National “Eleventh-five” Scientific Item(2006BAI01A06); Shen-zhen City Luohu District Foundation (2007029)." Journal of Nanjing Medical University, Vol. 22 (No. 3), pp. 188-92, 2008/05/01/ (2008).
19- Abolhasan Shakeri Bavil, Homa Akbari, Reza Javadrashid, Mohammad Hosein Abdekarimi, Mohammad Reza Ghafari, and Hosein Namdar, "CT Angiographic Findings of Right Ventricular Dysfunction in Patients with Acute Massive Pulmonary Embolism." Med J Tabriz Uni Med Sciences Health Services, Vol. 36 (No. 1), pp. 46-51, 2014/4/6 (2014).
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Issue | Vol 11 No 4 (2024) | |
Section | Original Article(s) | |
DOI | https://doi.org/10.18502/fbt.v11i4.16506 | |
Keywords | ||
Computed Tomography Pulmonary Angiography Echocardiography Pulmonary Thromboembolism Heart Failure |
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