Abstract
The aim of the study was to determine the usefulness of the radiological cardiothoracic ratio (CTR) as a predictor of right ventricular enlargement in patients with suspected pulmonary embolism during COVID-19. The study group consisted of 61 patients with confirmed COVID-19, suspected of pulmonary embolism based on physical examination and laboratory tests (age: 67.18 ± 12.47 years). Computed tomography angiography (CTA) of pulmonary arteries and chest radiograph in AP projection with cardiothoracic ratio assessment were performed in all patients. Right ventricular enlargement was diagnosed by the ratio of right ventricular to left ventricular (RV/LV) dimensions in pulmonary CTA with two cut-off points: ≥0.9 and ≥1.0. Heart silhouette enlargement was found when CTR on the chest radiograph in the projection AP > 0.55. The mean values of RV/LV and CTR in the studied group were 0.96 ± 0.23 and 0.57 ± 0.05, respectively. Pulmonary embolism was diagnosed in 45.9%. Right ventricular enlargement was documented in 44.3% or 29.5% depending on the adopted criterion RV/LV ≥ 0.9 or RV/LV ≥ 1.0. Heart silhouette enlargement was found in 60.6%. Patients with confirmed pulmonary embolism (PE+) had a significantly higher RV/LV ratio and CTR than patients with excluded pulmonary embolism (PE−) (RV/LV: PE+ 1.08 ± 0.24, PE− 0.82 ± 0.12; CTR: PE+ 0.60 ± 0.05, PE− 0.54 ± 0.04; p < 0.05). The correlation analysis showed a statistically significant positive correlation between the RV/LV ratio and CTR (r = 0.59, p < 0.05). Based on the ROC curves, CTR values were determined as the optimal cut-off points for the prediction of right ventricular enlargement (RV/LV ≥ 0.9 or RV/LV ≥ 1.0), being 0.54 and 0.55, respectively. The sensitivity, specificity, and accuracy of the CTR criterion >0.54 as a predictor of RV/LV ratio ≥0.9 were 0.412, 0.963, and 0.656, respectively, while those of the CTR criterion >0.55 as a predictor of RV/LV ratio ≥1.0 were 0.488, 0.833, and 0.590, respectively. In summary, in patients with suspected pulmonary embolism during COVID-19, the radiographic cardiothoracic ratio can be considered as a prognostic factor for right ventricular enlargement, especially as a negative predictor of right ventricular enlargement in the case of lower CTR values.
Highlights
The virus SARS-CoV-2 causes a complex of symptoms of a viral respiratory infection, in severe cases causing acute respiratory failure and death [1]
The purpose of the study was to determine the usefulness of the cardiothoracic ratio (CTR) as a predictor of right ventricular enlargement in patients with suspected pulmonary embolism secondary to COVID-19
Based on the computed tomography angiography (CTA) of the pulmonary arteries, pulmonary embolism was diagnosed in 45.9% of the subjects
Summary
The virus SARS-CoV-2 causes a complex of symptoms of a viral respiratory infection, in severe cases causing acute respiratory failure and death [1]. The literature provides numerous reports regarding a series of cardiovascular complications secondary to COVID-19 [4,5]. Cardiogenic shock and cardiomyopathy [6]. Another issue related to the COVID-19 infection is the frequent occurrence of pulmonary embolism and deep vein thrombosis, more common than in the course of other viral infections (e.g., the H1N1 flu virus) [9,10]. Meta-analysis demonstrated respectively 16.5% and 14.8% occurrence of acute pulmonary embolism and deep vein thrombosis in patients infected with COVID-19, whereas more than a half of the patients with pulmonary embolism did not suffer from deep vein thrombosis [11]
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