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Abstract: Poster Presentations |

ASSESSMENT OF OUTCOME IN ACUTE PULMONARY EMBOLISM BY SPIRAL COMPUTED TOMOGRAPHY OF THE CHEST CRITERIA FREE TO VIEW

Vladimir Sabayev, MD; John Iraj, MD; Mustafa A. Salehmohamed, DO; Lusine Melik-Adamyan, MD; O Neil J. Green
Author and Funding Information

New York Hospital/Queens, Fresh Meadows, NY


Chest


Chest. 2009;136(4_MeetingAbstracts):142S. doi:10.1378/chest.136.4_MeetingAbstracts.142S
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Abstract

PURPOSE:  Spiral computed tomography (CT-PA) of the chest criteria has been used to predict in-hospital morbidity and right ventricular (RV) dysfunction in patients with acute pulmonary embolism (PE). Those commonly used are right to left ventricular (RV/LV) diameter ratio; left ventricular (LV) septal bowing; pulmonary artery to aorta ( PA/Ao) diameter ratio and oligemia. We aimed to determine if these signs predict adverse outcome and were associated with RV dysfunction on echocardiogram in patients with pulmonary embolism.

METHODS:  We reviewed patients with PE diagnosed by CT-PA from 2006 to 2007. CT-PAs were reviewed for LV septal bowing; RV/LV diameter ratio; PA/Ao diameter ratio and oligemia by a radiologist. Echocardiograms were reviewed for RV dysfunction. Adverse outcome was defined as need for vasopressors, mechanical ventilation, administration of thrombolytics, hospitalization for > 13 days or death. Patients were analyzed in two groups based on outcomes.

RESULTS:  Of 46 patients adverse outcome was present in 15; shock 3 (6.67%), mechanical ventilation 3 (6.67%), use of thrombolytics 4 (8.89%) and death 3 (6.67%). RV/LV ratio was 1.22 with good outcome (A) versus 1.25 with poor outcome (B), p = 0.721.Septal bowing was present in 35% and 40% respectively in both groups. PA/Ao diameter ratio was 1.17 in group A versus 0.93 in group B, p = 0.397. Oligemia was present in 6 (19%) of group A and 1 (7%) in group B. RV dysfunction was present in 8 (26%) of group A and 7 (47%) of group B. Troponin was > 0.05 in 11 (35%) of group A versus 5 (33%) in group B.

CONCLUSION:  In our study CT-PA criteria did not predict poor outcome or presence of RV dysfunction in patients with PE.

CLINICAL IMPLICATIONS:  Contrary to previous studies we didnot find CT-PA signs of RV dysfunction to be predictive for adverse outcome.

DISCLOSURE:  O Neil Green, No Financial Disclosure Information; No Product/Research Disclosure Information

Wednesday, November 4, 2009

12:45 PM - 2:00 PM


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