The Prognostic Significance of Pulmonary CT Angiography in Predicting the Outcomes of Acute Pulmonary Thromboembolism

Abstract

Background: Pulmonary embolism (PE) is a potentially fatal condition. Knowledge of the prognostic factors for PE may facilitate the management of these patients. Pulmonary computed tomography (CT) angiography (PCTA) can play an effective role in their management. Objectives: To evaluate the prognostic value of certain PCTA-derived indicators of right ventricular dysfunction in patients with acute PE. Patients and Methods: A total of 61 hemodynamically stable patients with acute PE underwent PCTA and were followed-up for 60 days. The Qanadli index and 60-day mortality represented the PE severity and prognostic endpoints, respectively. The clinical significance of the following variables in predicting PE severity and mortality was examined: An abnormally positioned interventricular septum, right ventricular to left ventricular diameter ratio (RVD/LVD) on the axial plane, contrast medium reflux into the inferior vena cava (IVC), transverse diameter of the pulmonary trunk, and bolus-time curve indicators. Results: The 60-day mortality was estimated at 14.8% in this study. An abnormal interventricular septum morphology, RVD/LVD ratio, and contrast medium reflux into the IVC were significantly correlated with the Qanadli index. The pulmonary trunk diameter was the only predictor of 60-day mortality (optimal cutoff value, 33.5 mm; sensitivity, 66.7%; and specificity, 65.4%). The bolus-time curve indicators did not have any significant predictive value. Conclusion: Some PCTA-derived indicators of right ventricular dysfunction may serve as severity/prognostic predictors in hemodynamically stable patients with acute PE.