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MULTIDETECTOR COMPUTED TOMOGRAPHY FOR ACUTE PULMONARY EMBOLISM: EMBOLIC BURDEN AND CLINICAL OUTCOME.
MedLine Citation:
PMID:  22628491     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
AbstractBackgroundIn patients with acute pulmonary embolism (PE) the correlation between the embolic burden assessed at multidetector computed tomography (MDCT) and clinical outcome remains unclear. Patients with symptomatic acute PE diagnosed by MDCT were included in a multicenter study aimed at assessing the prognostic role of the embolic burden evaluated at MDCT.MethodsEmbolic burden was assessed as i) localization of the emboli: central (saddle or at least one main pulmonary artery), lobar or distal (segmental or sub-segmental arteries) and ii) the obstruction index (OI) by the scoring system of Qanadli. The primary outcome was 30-day all-cause-death and/or clinical deterioration. Predictors of all-cause-death and/or clinical deterioration were identified by Cox regression statistics.ResultsOverall 579 patients were included in the study; 60 (10.4%) died or had clinical deterioration at 30 days. Central localization of emboli was not associated with all-cause-death and/or clinical deterioration (hazard ratio [HR] 2.42; 95% CI 0.77-7.59, p=0.13). However, in the 516 hemodynamically stable patients, central localization of emboli (HR 8.3, 95% CI 1.0-67, p=0.047) was an independent predictor of all-cause-death and/or clinical deterioration while distal emboli were inversely associated with these outcome events (HR 0.12, 95% CI 0.015-0.97, p=0.047). No correlation was found between OI (evaluated in 448 patients) and all-cause-death and/or clinical deterioration in the overall study population and in hemodynamically stable patients.ConclusionsIn hemodynamically stable patients with acute PE, central emboli are associated with an increased risk for all-cause-death and/or clinical deterioration; this risk is low in patients with segmental or subsegmental PE.
Authors:
Maria Cristina Vedovati; Cecilia Becattini; Giancarlo Agnelli; Pieter W Kamphuisen; Luca Masotti; Piotr Pruszczyk; Franco Casazza; Aldo Salvi; Stefano Grifoni; Anna Carugati; Stavros Konstantinides; Marthe Schreuder; Marek Golebiowski; Michele Duranti
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-5-24
Journal Detail:
Title:  Chest     Volume:  -     ISSN:  1931-3543     ISO Abbreviation:  -     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-5-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
(1)Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Perugia, Italy;
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