Abstract
The aim of this study was to build a formula to predict short-term prognosis using main pulmonary artery (MPA) parameters reconstructed from computed tomographic pulmonary angiography in non-high-risk acute pulmonary embolism (PE) patients. After reconstructing the MPA and its centerline, the MPA, the right and left pulmonary artery inlet, and the MPA outlet plane were differentiated to measure the cross-sectional area (CSA), the maximal diameter and the hydraulic diameter. The MPA bifurcation area, volume and angle were measured. MPA dilation was defined as >29 mm at the transverse section plane. The patients were randomly divided into a training set and a validation set. A least absolute shrinkage and selection operator (LASSO) logistic regression algorithm was used to build a predictive formula. The performances of the predictive formula from LASSO were tested by the area under the receiver operating characteristic curve (AUC) and precision-recall (PR) curve with 10-fold cross-validation. The clinical utility was assessed by decision curve analysis (DCA). In total, 296 patients were enrolled and randomly divided (50:50) into a training set and a validation set. The LASSO predictive formula (lambda.1SE) was as follows: 0.92 × MPA bifurcation area + 0.50 × MPA outlet hydraulic diameter + 0.10 × MPA outlet CSA. The AUCs of the predictive formula were 0.860 (95% CI: 0.795–0.912) and 0.943 (95% CI: 0.892–0.975) in the training set and validation set, respectively. The LASSO predictive formula had a higher average area under the PR curve than MPA dilation (0.71 vs. 0.23 in the training set and 0.55 vs. 0.23 in the validation set) and added a net benefit in clinical utility by DCA. Integration of MPA outlet CSA, hydraulic diameter, and bifurcation area with the LASSO predictive formula as a novel weighting method facilitated the prediction of poor short-term prognosis within 30 days after hospital admission in non-high-risk acute PE patients.
Highlights
The high-risk group of acute pulmonary artery (PE) patients exhibits greater than 50% mortality with identifiable hypotension characteristics
There are different strategies for predicting the short prognosis of non-high-risk acute PE patients, such as simplified pulmonary embolism severity (s-PESI), which is useful for the identification of low-risk patients (Lankeit, 2017), and Bova scores, which are reported to miss the diagnosis of some adverse events in short-term follow-up (Fernandez et al, 2015)
We propose that evaluating the main pulmonary artery (MPA) crosssectional area (CSA), hydraulic diameter, maximal diameter and MPA bifurcation size on Computed tomography pulmonary angiography (CTPA) may be a superior method of predicting short-term prognosis
Summary
The high-risk group of acute pulmonary artery (PE) patients exhibits greater than 50% mortality with identifiable hypotension characteristics. The mortality of non-high-risk acute PE patients who are hemodynamically stable remains at 1–10% in the short term (Becattini et al, 2014). Identifying non-highrisk acute PE patients with a poor short-term prognosis is difficult but is an effective method to decrease mortality (Konstantinides et al, 2014). The main pulmonary artery (MPA) cannot react to inflammation and hypoxemia but reflects total PH severity due to its high sensitivity to pressure (Aviram et al, 2011). MPA size evaluated by CTPA (Aviram et al, 2015) is considered a potential predictor of short-term prognosis (Gutte et al, 2017; Beenen et al, 2018). Measurement of the MPA diameter does not represent the MPA size due to tissue compression and good resilience and flexibility of the MPA (Malhotra et al, 2016)
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