Document Detail

Computed tomographic pulmonary angiography in the assessment of severity of acute pulmonary embolism and right ventricular dysfunction.
MedLine Citation:
PMID:  19488895     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The distinction between severe pulmonary embolism (PE) and right heart dysfunction is important for predicting patient mortality. PURPOSE: To identify the role of computed tomographic pulmonary angiography (CTPA) in the assessment of the severity of acute PE and right ventricular dysfunction. MATERIAL AND METHODS: Eighty-five patients suspected of having PE, as diagnosed by CTPA and scintigraphy, were divided into three groups: hemodynamically unstable PE (HUPE) (n = 20), hemodynamically stable PE (HSPE) (n = 33), and no PE (n = 32). For each patient, obstruction scores, including short-axis diameters of the right ventricle (RV) and left ventricle (LV), main pulmonary artery, and superior vena cava (SVC), were measured. The RV/LV short-axis ratios were calculated. The shapes of the interventricular septum and the reflux of the contrast medium into the inferior vena cava (IVC) were evaluated. The mortality due to PE within a 1-month follow-up period was recorded. RESULTS: The median CTPA obstruction score (HUPE 64%, HSPE 28%, P < 0.001), median RV/LV short-axis ratio (HUPE 1.4, HSPE 1.0, P < 0.01), median RV diameter (HUPE 55 mm, HSPE 42 mm, P < 0.001), median SVC diameter (HUPE 23 mm, HSPE 19 mm, P < 0.01), interventricular septum convex toward the LV (HUPE 70%, HSPE 18%, P < 0.001), and reflux of the contrast medium into the IVC (HUPE 65%, HSPE 33%, p < 0.05) were significantly different between the HUPE and HSPE groups. With ROC analysis, the CTPA obstruction score and RV/LV short-axis ratio threshold values for the HUPE patients were calculated to be 48% (95% sensitivity, 76% specificity) and 1.1 (85% sensitivity, 76% specificity), respectively. Three patients in the HUPE group died within the first 24 hours. Logistic regression methods revealed only the RV diameter as a significant predictor of death (odds ratio 1.24; 95% CI 1.04-1.48; P = 0.01). CONCLUSION: This study found that the parameters useful for distinguishing HUPE and HSPE included CTPA obstruction score, RV and SVC diameters, RV/LV short-axis ratio, interventricular septum shape, and reflux into the IVC. RV dilatation may be a significant predictor for mortality.
M S Nural; M Elmali; S Findik; O Yapici; O Uzun; A T Sunter; L Erkan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acta radiologica (Stockholm, Sweden : 1987)     Volume:  50     ISSN:  1600-0455     ISO Abbreviation:  Acta Radiol     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-06-23     Completed Date:  2009-07-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8706123     Medline TA:  Acta Radiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  629-37     Citation Subset:  IM    
Department of Radiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
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MeSH Terms
Acute Disease
Angiography / methods
Contrast Media / diagnostic use
Follow-Up Studies
Heart Ventricles / radiography
Iohexol / analogs & derivatives,  diagnostic use
Middle Aged
Predictive Value of Tests
Pulmonary Artery / radiography*
Pulmonary Embolism / complications,  radiography*
ROC Curve
Radiographic Image Enhancement / methods
Sensitivity and Specificity
Severity of Illness Index
Tomography, X-Ray Computed / methods
Ventricular Dysfunction, Right / complications,  radiography*
Reg. No./Substance:
0/Contrast Media; 66108-95-0/Iohexol; 73334-07-3/iopromide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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