PURPOSE: RVD demonstrated on echocardiogram(ECHO)has been recognized as an adverse prognostic indicator in patients with PE and normal bloodpressure,with both mortality and reembolisation rates being higher than in patients without RVD.As CTangiography is often now the first diagnostic study done,it’s ability to detect RVD would be of significant clinical value.To retrospectively evaluate the ability of spiral CT to detect RVD in setting of acute PE.
METHODS: Retrospective study of 32 patients diagnosed at Coney Island hospital with pulmonary embolism from 2002–2006,who have had both ECHO and CTangiography done.RVD was deemed present if ECHO showed one of following:1.Pulmonary hypertension with measured PA systolic pressure>402.Dilated right atrium and right ventricle(RV) with or without D-sign3.Paradoxical motion of interventricularseptum. 4.Septal hypokinesis with apical sparing.Patients with preexisting LV dysfunction or pulmonaryhypertension were identified and excluded.RVD was deemed present in the spiral CT if1.RV/LV ratio of 1 or more2.PA/AO ratio of 1 or more Ventricular dimensions were measured on a single tranverse scan perpendicular to long axis of heart and were defined as the largest distance between inner aspect of interventicular septum and free wall of ventricle(fig included).The measurements of main pulmonary artery(PA)and aorta(AO)were also obtained.
RESULTS: 21/32 patients had fulfilled echo criteria for RV dysfunctiion(RVD+).11/32 patients did not have RV dysfunction(RVD−).Mean RV/LV ratio in (RVD+)patients=1.3Mean RV/LV ratio in patients without RVD(RVD−)=0.8Mean PA/Ao ratio in (RVD+)patients=1.02Mean PA/Ao ratio in (RVD−)patients=0.9The sensitivity and specificity, positive predictive value and negative predictive value were calculated using RV/LV ratio of 1 and PA/AO ratio of 1. TABLE included.
CONCLUSION: Spiral CT is an accurate imaging modality to identify RVD in patients with acute PE.The ratio of RV diameter to LV diameter of 1 or more than one serves to identify RVD with more accuracy than PA diameter to AO diameter ratio.
CLINICAL IMPLICATIONS: Spiral CT in setting of acute PE provides both diagnostic & prognostic information regarding the embolic event. Its ability to identify high risk patient on initial testing avoids need for the ECHO&the delay entailed in echo identification of RVD.
DISCLOSURE: Anitha Angan, None.