EVALUATION OF RIGHT VENTRICULAR DYSFUNCTION AND MORTALITY WITH CT ANGIOGRAPHY PARAMETERS OF ACUTE PULMONARY EMBOLISM

ADEM MELEKOGLU, MD*, SEDA OZKAN, MD, ASSOC. PROF.**, SERRA OZBAL GUNES, MD***, TOLGA CIMEN, MD****

*Department of Emergency Medicine, University of Health Sciences, Sisli Etfal Training and Research Hospital, Istanbul, Turkey - **Department of Emergency Medicine, University of Health Sciences, Diskapi Yildirim Beyazi Training and Research Hospital, Ankara, Turkey - ***Department of Radiology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey - ****Department of Cardiology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey

Introduction: Right ventricular dysfunction is an independent and significant predictor of a poor prognosis in patients with an acute pulmonary embolism. Right ventricular overload can be detected along with pulmonary embolism via computed tomography angiography. We aimed to evaluate the accuracy of CT angiography parameters in diagnosing right ventricular dysfunction and predicting mortality in acute pulmonary embolism.

Materials and methods: One hundred and twenty-six patients were included in the study. Main pulmonary arterial diameters, right and left main pulmonary arterial diameters, and ventricular diameters and ratios were measured by obtaining a large sequence of thoracic CT angiography images. Qanadli scores and Qanadli obstruction indices were calculated. Echocardiography was performed in all patients to determine right ventricular dysfunction.

Results: A significant difference in CT measurements was noted between patients who were diagnosed with right ventricular dilatation on echocardiography and those who were not (p<0.05). Regarding the diagnosis of right heart failure, CT angiography demonstrated a sensitivity of 89% in patients who were found to have a Right Ventricle/Left Ventricle diameter ratio >0.9. The AUCs for the diagnosis of right heart failure via CT angiography were 0.63 for the Qanadli score, 0.78 for the Right Ventricle/Left Ventricle diameter ratio, 0.71 for main pulmonary arterial diameter, and 0.79 for right ventricular diameter. The AUCs for the prediction of mortality based on CT angiography findings were 0.51 for the Qanadli score, 0.61 for the Right Ventricle/Left Ventricle diameter ratio, 0.53 for main pulmonary arterial diameter, and 0.55 for right ventricular diameter. Notably, increased main pulmonary arterial diameter, which was calculated via tomography, was related to a high systolic pulmonary artery pressure.

Conclusion: CT angiography is an imaging technique that can be used to diagnose right ventricular dilatation in patients with acute pulmonary embolism and to determine disease prognosis and appropriate treatment strategies.