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.
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.
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.
In our study CT-PA criteria did not predict poor outcome or presence of RV dysfunction in patients with PE.
Contrary to previous studies we didnot find CT-PA signs of RV dysfunction to be predictive for adverse outcome.
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