Axial and reformatted four-chamber right ventricle-to-left ventricle diameter ratios on pulmonary CT angiography as predictors of death after acute pulmonary embolism.

Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
American Journal of Roentgenology (Impact Factor: 2.9). 06/2012; 198(6):1353-60. DOI: 10.2214/AJR.11.7439
Source: PubMed

ABSTRACT The purpose of this article is to retrospectively compare right ventricular-to-left ventricular (RV/LV) diameter ratios measured on the standard axial view versus the reformatted four-chamber view as predictors of mortality after acute pulmonary embolism (PE).
Six hundred seventy-four consecutive patients (mean age, 58 years; 372 women) with a diagnosis of acute PE on pulmonary CT angiography were considered. The axial and reformatted four-chamber RV/LV diameter ratios were compared as predictors of 30-day all-cause and PE-related mortality.
Ninety-seven patients (14%) died within 30 days; 39 deaths were PE related. There was no significant difference in the univariate hazard ratios (HRs) of axial and four-chamber RV/LV diameter ratios greater than 0.9 for both all-cause (HR, 2.13 [95% CI, 1.29-3.51] vs HR, 1.95 [95% CI, 1.22-3.14]; p = 0.74) and PE-related (HR, 19.6 [95% CI, 2.70-143] vs HR, 21.8 [95% CI, 2.99-158]; p = 1.0) mortality. Axial and four-chamber multivariate HRs accounting for potential confounders such as age and cancer were also similar for all-cause (HR, 1.79 [95% CI, 1.07-2.99] vs HR, 1.54 [95% CI, 0.95-2.49]; p = 0.62) and PE-related (HR, 16.3 [95% CI, 2.22-119] vs HR, 17.7 [95% CI, 2.43-130]; p = 1.0) mortality. There was no significant difference in sensitivity, specificity, negative predictive value, or positive predictive value. Axial and four-chamber measurements were well correlated (correlation coefficient, 0.857), and there was no significant difference in overall accuracy for predicting all-cause (area under the curve [AUC], 0.582 vs 0.577; p = 0.72) and PE-related (AUC, 0.743 vs 0.744; p = 1.0) mortality.
The axial RV/LV diameter ratio is no less accurate than the reformatted four-chamber RV/LV diameter ratio for predicting 30-day mortality after PE.

  • [Show abstract] [Hide abstract]
    ABSTRACT: A left-bulging atrial septum (AS) is an abnormal sign indicating hemodynamic overloading of the right heart. We tried to evaluate whether computed tomography (CT)-derived AS bulging and ventricular septum (VS) bowing signs would be used to identify patients with acute pulmonary embolism (PE) and significant hemodynamic derangements. In the prospective registry, 208 consecutive patients with a first episode of acute PE diagnosed by chest CT were grouped by clinical hemodynamic assessment: massive or submassive PE (Group 1), and small PE (Group 2). The curvatures of the AS and VS, and the diameters of right ventricle (RV) and left ventricle were measured on chest CT. Group 1 showed higher degrees of echocardiographic RV dysfunction, and abnormal CT-derived VS and AS curvatures versus Group 2. An abnormal VS bowing sign was observed in 32 (32.7 %) and 6 (5.5 %) patients in Groups 1 and 2, respectively (P < 0.001). An abnormal AS bulging sign was observed in 59 (60.2 %) and 32 (29.1 %) patients in Groups 1 and 2, respectively (P < 0.001). An algorithm was designed to predict clinically significant hemodynamic abnormality based on these signs. The patients deemed "higher risk" exhibited higher 90-day all-cause mortality than patients in the lower-risk group (P = 0.029). Conventional chest CT-derived hemodynamic findings, including abnormal AS and VS signs, can be used to identify high-risk patients with acute PE and to predict early mortality.
    The international journal of cardiovascular imaging 04/2014; · 2.15 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This article highlights new areas of interest in the management of patients with acute pulmonary embolism, with the objective of alerting radiologists about necessary updates for daily practice.
    Radiologic Clinics of North America 01/2014; 52(1):183-193. · 1.95 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Right heart evaluation on coronary computed tomography angiography (CCTA) is underutilized due to nonopacification of the right heart chambers and poor endocardial resolution. We analyzed feasibility and reproducibility of right heart functional analysis by measuring CCTA-based tricuspid annular plane systolic excursion (CT-TAPSE) on ECG-gated CCTA and correlated the results with 2D transthoracic echocardiography (TTE)-derived TAPSE (Echo-TAPSE). CT-TAPSE was measured on a total population of 41 patients who had CCTA and TTE performed within 6 months of each other. Two independent CCTA readers performed analysis on reformatted four-chamber view. Intra- and inter-observer variability analysis was performed on 16 randomly selected patients. Correlative (Spearman's R) and Bland-Altman analysis was used to assess the level of agreement between the 2 methods and to compare CT-TAPSE with Echo-TAPSE. CT-TAPSE measured by Readers 1 and 2 on 16 randomly selected patients, demonstrated excellent intra-observer and inter-observer agreement, with very close correlation (R > 0.80 and 2-tailed P-value of <0.001). When tested in the entire study population of 41 patients, CT-TAPSE correlated closely with Echo-TAPSE (R = 0.738, P < 0.001). Bland-Altman analysis indicated that the 2 methods provided similar measures as majority of values lay within the 95% confidence limits. Based on abnormal Echo-TAPSE cutoff value of <16 mm, CT-TAPSE identified impaired right ventricle (RV) function with sensitivity of 82% and specificity of 93%, respectively. We demonstrated feasibility and reproducibility of assessing TAPSE on coronary CTA. RV functional analysis utilizing CT-TAPSE is simple and reproducible methodology, and is in close agreement with Echo-TAPSE.
    Echocardiography 01/2014; · 1.26 Impact Factor