0
Original Research: Pulmonary Vascular Disease |

Multidetector CT Scan for Acute Pulmonary EmbolismEmbolic Burden and Prognosis in Pulmonary Embolism: Embolic Burden and Clinical Outcome

Maria Cristina Vedovati, MD; Cecilia Becattini, MD; Giancarlo Agnelli, MD; Pieter W. Kamphuisen, MD; Luca Masotti, MD; Piotr Pruszczyk, MD; Franco Casazza, MD; Aldo Salvi, MD; Stefano Grifoni, MD; Anna Carugati, MD; Stavros Konstantinides, MD; Marthe Schreuder, MD; Marek Golebiowski, MD; Michele Duranti, MD
Author and Funding Information

From the Internal and Cardiovascular Medicine–Stroke Unit (Drs Vedovati, Becattini, and Agnelli), University of Perugia, and Department of Radiology (Dr Duranti), S Maria della Misericordia Hospital, Perugia, Italy; Department of Vascular Medicine (Drs Kamphuisen and Schreuder), University Medical Center Groningen, Groningen, The Netherlands; Department of Internal Medicine (Dr Masotti), Cecina Hospital, Cecina, Italy; Department of Internal Medicine and Cardiology (Dr Pruszczyk) and Department of Radiology (Dr Golebiowski), Warsaw Medical University, Warsaw, Poland; Department of Cardiology (Dr Casazza), San Carlo Borromeo Hospital, Milan, Italy; Department of Emergency Medicine (Dr Salvi), Ancona Hospital, Ancona, Italy; Department of Emergency Medicine (Dr Grifoni), Careggi Hospital, Florence, Italy; Department of Internal Medicine (Dr Carugati), Valduce Hospital, Como, Italy; and Department of Cardiology (Dr Konstantinides), Democritus University of Thrace, Alexandroupolis, Greece.

Correspondence to: Maria Cristina Vedovati, MD, Internal and Cardiovascular Medicine–Stroke Unit, via G. Dottori, S. Maria della Misericordia Hospital, 06123 Perugia, Italy; e-mail: mcristinaved@yahoo.it


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(6):1417-1424. doi:10.1378/chest.11-2739
Text Size: A A A
Published online

Background:  In patients with acute pulmonary embolism (PE), the correlation between the embolic burden assessed by multidetector CT (MDCT) scan and clinical outcomes remains unclear. Patients with symptomatic acute PE diagnosed based on MDCT angiography were included in a multicenter study aimed at assessing the prognostic role of the embolic burden evaluated with MDCT scan.

Methods:  Embolic burden was assessed as (1) localization of the emboli as central (saddle or at least one main pulmonary artery), lobar, or distal (segmental or subsegmental arteries) and (2) the obstruction index by the scoring system of Qanadli. The primary outcome was 30-day all-cause death or clinical deterioration. Predictors of all-cause death or clinical deterioration were identified by Cox regression statistics.

Results:  Overall, 579 patients were included in the study; 60 (10.4%) died or had clinical deterioration at 30 days. Central localization of emboli was not associated with all-cause death or clinical deterioration (hazard ratio [HR], 2.42; 95% CI, 0.77-7.59; P = .13). However, in 516 hemodynamically stable patients, central localization of emboli (HR, 8.3; 95% CI, 1.0-67; P = .047) was an independent predictor of all-cause death or clinical deterioration, whereas distal emboli were inversely associated with these outcome events (HR, 0.12; 95% CI, 0.015-0.97; P = .047). No correlation was found between obstruction index (evaluated in 448 patients) and all-cause death or clinical deterioration in the overall study population and in the hemodynamically stable patients.

Conclusions:  In hemodynamically stable patients with acute PE, central emboli are associated with an increased risk for all-cause death or clinical deterioration. This risk is low in patients with segmental or subsegmental PE.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543