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CT signs of right ventricular dysfunction: prognostic role in acute pulmonary embolism.

Kang, DK; Thilo, C; Schoepf, UJ; Barraza, JM Jr; Nance, JW Jr; Bastarrika, G; Abro, JA; Ravenel, JG; Costello, P; Goldhaber, SZ
JACC. Cardiovascular imaging, 4(8):841-849, 2011
Journal Title
JACC. Cardiovascular imaging
OBJECTIVES: The purpose of this study was to compare the prognostic role of various computed tomography (CT) signs of right ventricular (RV) dysfunction, including 3-dimensional ventricular volume measurements, to predict adverse outcomes in patients with acute pulmonary embolism (PE).

BACKGROUND: Three-dimensional ventricular volume measurements based on chest CT have become feasible for routine clinical application; however, their prognostic role in patients with acute PE has not been assessed.

METHODS: We evaluated 260 patients with acute PE for the following CT signs of RV dysfunction obtained on routine chest CT: abnormal position of the interventricular septum, inferior vena cava contrast reflux, right ventricle diameter (RVD) to left ventricle diameter (LVD) ratio on axial sections and 4-chamber (4-CH) views, and 3-dimensional right ventricle volume (RVV) to left ventricle volume (LVV) ratio. Comorbidities and fatal and nonfatal adverse outcomes according to the MAPPET-3 (Management Strategies and Prognosis in Pulmonary Embolism Trial-3) criteria within 30 days were recorded.

RESULTS: Fifty-seven patients (21.9%) had adverse outcomes, including 20 patients (7.7%) who died within 30 days. An RVD(axial)/LVD(axial) ratio >1.0 was not predictive for adverse outcomes. On multivariate analysis (adjusting for comorbidities), abnormal position of the interventricular septum (hazard ratio [HR]: 2.07; p = 0.007), inferior vena cava contrast reflux (HR: 2.57; p = 0.001), RVD(4-CH)/LVD(4-CH) ratio >1.0 (HR: 2.51; p = 0.009), and RVV/LVV ratio >1.2 (HR: 4.04; p 1.0 (HR: 3.68; p = 0.039) and RVV/LVV ratio >1.2 (HR: 6.49; p = 0.005) were predictive of 30-day death.

CONCLUSIONS: Three-dimensional ventricular volume measurement on chest CT is a predictor of early death in patients with acute PE, independent of clinical risk factors and comorbidities. Abnormal position of the interventricular septum, inferior vena cava contrast reflux, and RVD(4-CH)/LVD(4-CH) ratio are predictive of adverse outcomes, whereas RVD(axial)/LVD(axial) ratio >1.0 is not.
MeSH terms
Acute DiseaseAdultAgedChi-Square DistributionFemaleHumansImaging, Three-DimensionalMaleMiddle AgedMultivariate AnalysisObserver VariationPredictive Value of TestsPrognosisProportional Hazards ModelsPulmonary Embolism/mortality/physiopathology/*radiographyRadiographic Image Interpretation, Computer-AssistedReproducibility of ResultsRetrospective StudiesRisk AssessmentRisk FactorsTime Factors*Tomography, X-Ray ComputedVentricular Dysfunction, Right/mortality/physiopathology/*radiography*Ventricular Function, Right
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Journal Papers > School of Medicine / Graduate School of Medicine > Radiology
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