2
|
Rotzinger DC, Knebel JF, Jouannic AM, Adler G, Qanadli SD. CT Pulmonary Angiography for Risk Stratification of Patients with Nonmassive Acute Pulmonary Embolism. Radiol Cardiothorac Imaging 2020; 2:e190188. [PMID: 33778598 DOI: 10.1148/ryct.2020190188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/24/2020] [Accepted: 04/21/2020] [Indexed: 01/21/2023]
Abstract
Purpose To investigate the prognostic value of an integrative approach combining clinical variables and the Qanadli CT obstruction index (CTOI) in patients with nonmassive acute pulmonary embolism (PE). Materials and Methods This retrospective study included 705 consecutive patients (mean age, 63 years; range, 18-95 years) with proven PE. Clot burden was quantified using the CTOI, which reflects the ratio of fully or partially obstructed pulmonary arteries to normal arteries. Patients were subdivided into two groups according to the presence (group A) or absence (group B) of preexisting cardiopulmonary disease. Thirty-day and 3-month mortality was evaluated. CTOI thresholds of 20% and 40% were used to stratify patients regarding outcome (low, intermediate, and high risk). The predictive value of CTOI was assessed through logistic regression analysis. Results Analysis included 690 patients (mean age, 63.3 years ± 18 [standard deviation]) with complete follow-up data: 247 (36%) in group A and 443 (64%) in group B. The mean CTOI was 23% ± 19, 30-day mortality was 9.7%, and 3-month mortality was 11.6%. Three-month mortality was higher in group A than in group B (17.8% and 8.1%, respectively; P = .001). Within group B, CTOI predicted outcome and allowed stratification: significantly higher mortality with CTOI greater than 40% (P < .001) and lower mortality with CTOI less than 20% (P = .05). CTOI did not predict outcome in group A. Age was an independent mortality risk factor (P ≤ .04). Conclusion CTOI predicted outcome in this cohort of patients with PE and no cardiopulmonary disease, and it may provide a simple single-examination-based approach for risk stratification in this subset of patients.© RSNA, 2020See also the commentary by Kay and Abbara in this issue.
Collapse
Affiliation(s)
- David C Rotzinger
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology (D.C.R., A.M.J., S.D.Q.) and EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology (J.F.K.), Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland (D.C.R., J.F.K., S.D.Q.); and Imagerive Diagnostic Radiology Institute, Geneva, Switzerland (G.A.)
| | - Jean-François Knebel
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology (D.C.R., A.M.J., S.D.Q.) and EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology (J.F.K.), Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland (D.C.R., J.F.K., S.D.Q.); and Imagerive Diagnostic Radiology Institute, Geneva, Switzerland (G.A.)
| | - Anne-Marie Jouannic
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology (D.C.R., A.M.J., S.D.Q.) and EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology (J.F.K.), Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland (D.C.R., J.F.K., S.D.Q.); and Imagerive Diagnostic Radiology Institute, Geneva, Switzerland (G.A.)
| | - Ghazal Adler
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology (D.C.R., A.M.J., S.D.Q.) and EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology (J.F.K.), Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland (D.C.R., J.F.K., S.D.Q.); and Imagerive Diagnostic Radiology Institute, Geneva, Switzerland (G.A.)
| | - Salah D Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology (D.C.R., A.M.J., S.D.Q.) and EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology (J.F.K.), Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland (D.C.R., J.F.K., S.D.Q.); and Imagerive Diagnostic Radiology Institute, Geneva, Switzerland (G.A.)
| |
Collapse
|
3
|
Lerche M, Bailis N, Akritidou M, Meyer HJ, Surov A. Pulmonary Vessel Obstruction Does Not Correlate with Severity of Pulmonary Embolism. J Clin Med 2019; 8:jcm8050584. [PMID: 31035342 PMCID: PMC6571763 DOI: 10.3390/jcm8050584] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/13/2019] [Accepted: 04/23/2019] [Indexed: 12/17/2022] Open
Abstract
The aim of the present study was to analyze possible relationships between pulmonary vessel obstruction and clinically relevant parameters and scores in patients with pulmonary embolism (PE). Overall, 246 patients (48.8% women and 51.2% men) with a mean age of 64.0 ± 17.1 years were involved in the retrospective study. The following clinical scores were calculated in the patients: Wells score, Geneva score, and pulmonary embolism severity index (PESI) score. Levels of D-dimer (µg/mL), lactate, pH, troponin, and N-terminal natriuretic peptide (BNP, pg/mL) were acquired. Thrombotic obstruction of the pulmonary arteries was quantified according to Mastora score. The data collected were evaluated by means of descriptive statistics. Spearman’s correlation coefficient was used to analyze associations between the investigated parameters. P values < 0.05 were taken to indicate statistical significance. Mastora score correlated weakly with lactate level and tended to correlate with D-dimer and BNP levels. No other clinical or serological parameters correlated significantly with clot burden. Thrombotic obstruction of pulmonary vessels did not correlate with clinical severity of PE.
Collapse
Affiliation(s)
- Marianne Lerche
- Department of Respiratory Medicine, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany.
| | - Nikolaos Bailis
- Department of Radiology, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany.
| | - Mideia Akritidou
- Department of Radiology, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany.
| | - Hans Jonas Meyer
- Department of Radiology, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany.
| | - Alexey Surov
- Department of Radiology, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany.
| |
Collapse
|
4
|
Adibi A, Nouri S, Moradi M, Shahabi J. Clinical and echocardiographic findings of patients with suspected acute pulmonary thromboembolism who underwent computed tomography pulmonary angiography. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 21:118. [PMID: 28255326 PMCID: PMC5331763 DOI: 10.4103/1735-1995.193509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/01/2016] [Accepted: 08/20/2016] [Indexed: 11/04/2022]
Abstract
Background: The aim of the study was to determine the correlation between clinical and echocardiographic findings and risk factors of patients with suspected acute pulmonary thromboembolism (PTE) who underwent computed tomography pulmonary angiography (CTPA). Materials and Methods: In this cross-sectional study, 310 hospitalized patients aged >18 years with high clinical suspicion of PTE referred to imaging center of our hospital from different wards for CTPA were enrolled. The frequency of different clinical presentations, risk factors, items of Wells’ criteria, and echocardiographic findings was compared in patients with and without PTE, which have been diagnosed according to the CTPA results. Results: PTE was diagnosed in 53 (17.1%) of patients with suspected PTE. From clinical manifestations, tachypnea, pleuritic chest pain, and edema of lower extremities were significantly more frequent among patients with PTE (P < 0.05). Major surgery was the risk factor which was significantly more prevalent among patients with PTE (P < 0.05). Frequency of all criteria of Wells’ criteria, except hemoptysis, was significantly higher in patients with PTE (P < 0.05). The frequency of all studied echocardiographic variables was significantly higher in patients with PTE (P < 0.05). Conclusion: It is suggested that we could use the results of this study for utilizing the diagnostic process of PTE in patients with highly clinical suspicion of PTE and providing more validated decision. Using the results of this study, we could identify high-risk patients and made appropriate risk assessment for better management of patients with suspected PTE as well as reduce the rate of unnecessary CTPA and its related adverse consequences.
Collapse
Affiliation(s)
- Atoosa Adibi
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shadi Nouri
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Moradi
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Javad Shahabi
- Department of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
5
|
Varol K, Gumus C, Yucel H, Sezer F, Seker E, Inci MF, Yucel S, Kaya H, Berk S, Yilmaz MB. Correlation of right ventricular dysfunction on acute pulmonary embolism with pulmonary artery computed tomography obstruction index ratio (PACTOIR) and comparison with echocardiography. Jpn J Radiol 2015; 33:311-6. [PMID: 25895158 DOI: 10.1007/s11604-015-0419-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/28/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to determine the pulmonary artery computed tomography obstruction index ratio (PACTOIR) in patients who have been diagnosed with acute pulmonary embolism (APE) with multi-slice computed tomography (MSCT) and to research the predetermination efficiency of right ventricular dysfunction (RVD) compared with echocardiography (ECHO). MATERIALS AND METHODS One hundred patients (50 males, 50 females), who had ECHO findings and were diagnosed with APE, were subsequently examined in this study. Patients who had RVD on ECHO, tricuspid regurgitation, and pulmonary hypertension parameters that were completely positive were accepted to have RVD. RESULTS RVD was identified in 52 patients (52 %) on echocardiography. The PACTOIR value for patients with RVD were evaluated to be significantly higher than those without RVD (41 ± 17 vs 20 ± 12 %, p < 0.001). In the ROC analysis, the PACTOIR cut-off value was 37.5 %, the sensitivity value was 67.3 %, and specificity value was 93.7 % (AUC 0.839, 95 % CI 0.752-0.905). We determined that the patients with RVD and PACTOIR values over 37.5 % can be recognized with a 92.1 % positive predictive value. CONCLUSION Our conclusions indicated that the PACTOIR rate in RVD diagnosis in patients with APE can recognize the patients with and without RVD.
Collapse
Affiliation(s)
- Kenan Varol
- Divison of Radiology, Amasya University SS Education and Research Hospital, Amasya, Turkey
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Trujillo-Santos J, den Exter PL, Gómez V, Del Castillo H, Moreno C, van der Hulle T, Huisman MV, Monreal M, Yusen RD, Jiménez D. Computed tomography-assessed right ventricular dysfunction and risk stratification of patients with acute non-massive pulmonary embolism: systematic review and meta-analysis. J Thromb Haemost 2013; 11:1823-32. [PMID: 23964984 DOI: 10.1111/jth.12393] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 08/15/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND The ability of computed tomography (CT)-assessed right ventricular dysfunction (RVD) to identify normotensive patients with acute pulmonary embolism (PE) at high risk of mortality or adverse outcome lacks clarity. METHODS AND RESULTS We performed a systematic review and a meta-analysis of studies in normotensive patients with acute PE to assess the prognostic value of CT-assessed RVD for death and a predefined composite outcome of PE-related complications. We conducted unrestricted searches of MEDLINE and EMBASE from 1980 to March 2013, and used the terms 'computed tomography', 'pulmonary embolism', and 'prognos*'. We used a random-effects model to pool study results, funnel-plot inspection to evaluate for publication bias, and I(2) testing to assess for heterogeneity. The analysis included data from 10 studies (2288 patients). Overall, 99 of 1268 patients with RVD assessed by CT died (7.8%; 95% confidence interval [CI] 6.3-9.3) as compared with 52 of 1020 without RVD (5.1%; 95% CI 3.7-6.4). CT-assessed RVD had significant associations with mortality (odds ratio [OR] 1.8; 95% CI 1.3-2.6), with death resulting from PE (OR 7.4; 95% CI 1.4-39.5), and with PE-related complications (OR 2.4; 95% CI 1.2-4.7). Pooled likelihood ratios (LRs) were not extreme (negative LR 0.71; 95% CI 0.57-0.89; and positive LR 1.27; 95% CI 1.12-1.43). CONCLUSIONS Although RVD assessed by CT showed an association with an increased risk of mortality in patients with hemodynamically stable PE, it resulted in only small increases in the ability to classify risk.
Collapse
Affiliation(s)
- J Trujillo-Santos
- Department of Medicine, Santa Lucía Hospital, Cartagena, Murcia, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|