Importance of computed tomography pulmonary angiography for predict 30-day mortality in acute pulmonary embolism patients

Narumol Chaosuwannakit; Wannaporn Soontrapa; Pattarapong Makarawate; Kittisak Sawanyawisuth

doi:10.1016/j.ejro.2021.100340

Importance of computed tomography pulmonary angiography for predict 30-day mortality in acute pulmonary embolism patients

Eur J Radiol Open. 2021 Mar 25:8:100340. doi: 10.1016/j.ejro.2021.100340. eCollection 2021.

Authors

Narumol Chaosuwannakit¹, Wannaporn Soontrapa¹, Pattarapong Makarawate², Kittisak Sawanyawisuth²

Affiliations

¹ Radiology Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
² Internal Medicine Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Abstract

Objective: The purpose of the present study was to assess the implications of different parameters of computed tomography pulmonary angiography (CTPA) to predict 30-day mortality in acute pulmonary embolism (APE) patients.

Material and method: Patients who had clinical suspicion of APE and underwent CTPA were recruited in a retrospective cohort study. The findings of the CTPA included the parameters of right ventricular dysfunction (RVD), the severity of obstruction to the pulmonary artery by CT obstruction index, and the ratio of pulmonary trunk diameter and aorta. The endpoint of the study was established as the 30-day mortality associated with APE.

Results: A total of 238 patients with a confirmed APE diagnosis with CTPA were included in the study; 26 (10.9 %) of those patients died within 30 days. In patients with cancer and the Pulmonary Embolism Severity Index (PESI) class 5, the mortality rate was significantly higher. Compared with survivors, the mean CT obstruction index in the non-survivor group was significantly higher (p < 0.001). Higher mortality was associated with all RVD parameters identified by CTPA, such as the RV/LV ratio (p < 0.001), interventricular septum deviation grade 3 (p < 0.001), increased RV diameter (p < 0.001), and IVC contrast reflux (p < 0.001). The highest adjusted odds ratio was RV diameter at 1.094, followed by PESI and the CT obstruction index at 1.040.

Conclusion: CTPA-detected RVD parameters and CT obstruction index can predict a 30-day mortality rate in APE patients and be used for risk stratification. In APE patients, the RV diameter of 53 mm or greater and the CT obstruction index >70% is associated with increased 30-day mortality.

Keywords: 30-day mortality; Acute pulmonary embolism; CTPA; Prognosis; RV diameter; RV dysfunction.