Abstract
Pulmonary embolism (PE) induces an acute increase in the right ventricle afterload that can lead to right-ventricular dysfunction (RVD) and eventually to circulatory collapse. Hemodynamic status and presence of RVD are important determinants of adverse outcomes in acute PE. Technologic progress allows computed tomography angiography (CTA) to give more information than accurate diagnosis of PE. It may also provide an insight into hemodynamics and right-ventricular function. Proximal localization of emboli, reflux of contrast medium to the hepatic veins, and right-to-left short-axis ventricular diameter ratio seem to be the most relevant CTA predictors of 30-day mortality. These elements require little postprocessing time, an advantage in the emergency room. We herein review the prognostic value of RVD and other CTA mortality predictors for patients with acute PE.
Highlights
Pulmonary embolism (PE) has a wide spectrum of presentations and severity
Pulmonary embolism (PE) induces an acute increase in the right ventricle afterload that can lead to right-ventricular dysfunction (RVD) and eventually to circulatory collapse
Whatever the cut-off used is, overall RVD assessed by computed tomography angiography (CTA) is observed in more than 50% of patients diagnosed with PE [4]
Summary
Pulmonary embolism (PE) has a wide spectrum of presentations and severity. Some patients present with shock, requiring urgent thrombolysis [1], while others can be safely treated on an outpatient basis with anticoagulation alone [2]. Echocardiography has become the standard procedure to evaluate RVD but requires skilled specialists and is not available around the clock in many hospitals [7]. Nowadays, computed tomography angiography (CTA) is by far the most commonly used modality to diagnose pulmonary embolism. Contrast medium flow is a dynamic process. Even if CTA produces static images, it provides clues for dynamic or functional parameters, making multislice chest CTA an attractive alternative to echocardiography for prognostic assessment. We will review indirect hemodynamic signs given by chest CTA and their impact on risk stratification
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