Axial and reformatted four-chamber right ventricle-to-left ventricle diameter ratios on pulmonary CT angiography as predictors of death after acute pulmonary embolism.
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.
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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
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ABSTRACT: In this paper we describe an efficient tool based on natural language processing for classifying the detail state of pulmonary embolism (PE) recorded in CT pulmonary angiography reports. The classification tasks include: PE present vs. absent, acute PE vs. others, central PE vs. others, and subsegmental PE vs. others. Statistical learning algorithms were trained with features extracted using the NLP tool and gold standard labels obtained via chart review from two radiologists. The areas under the receiver operating characteristic curves (AUC) for the four tasks were 0.998, 0.945, 0.987, and 0.986, respectively. We compared our classifiers with bag-of-words Naive Bayes classifiers, a standard text mining technology, which gave AUC 0.942, 0.765, 0.766, and 0.712, respectively.Journal of biomedical informatics. 08/2014;
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ABSTRACT: Clinical History An 88-year-old man with history of aortic stenosis presented with worsening dyspnea and underwent workup for TAVR (transcatheter aortic valve replacement). His medications included warfarin for a remote history of deep venous thrombosis. Physical exam was remarkable for a grade 3 systolic crescendo-decrescendo murmur. Cardiac ultrasound confirmed severe aortic stenosis with mean gradient of 78 mm Hg, peak gradient of 142 mm Hg, and calculated valve area of 0.7 cm2. The pulmonary arteries and right ventricle were dilated, the right ventricular systolic pressure was estimated at 101 mm Hg, with severe tricuspid insufficiency. Cardiac catheterization revealed a right atrial pressure of 5 mm Hg, pulmonary artery systolic pressure of 70 mm Hg, and a pulmonary capillary wedge pressure of 10 mm Hg. Aortic valve replacement was considered by the multidisciplinary structural heart disease team. The patient was at increased operative risk due to age and frailty, and so TAVR was thought to be preferable. Findings Cardiac CT angiography (CTA) revealed a sclerotic and stenotic aortic valve, as well as a large chronic pulmonary thromboembolism in the right main pulmonary artery, dilated main and peripheral pulmonary arteries, and bronchial artery enlargement. The right ventricle was enlarged with an RV:LV ratio of greater than 1.3:1 (normal = 1:1 or less). Discussion Chronic pulmonary thromboembolism in this patient resulted in pulmonary artery hypertension and right heart strain, compounding his symptoms. A normal APRIL 2014 ISSUE 61 Figure 1 Figure 2 Figure 3 Figure 4 pulmonary capillary wedge pressure makes the presence of left-sided heart disease as a cause of right-heart disease unlikely. Chronic pulmonary thromboembolism typically results from incomplete resolution of acute pulmonary embolism. Symptoms result from development of pulmonary artery hypertension. Diagnosis on CTA is based on pulmonary artery findings such as complete or partial obstruction, filling defects which are typically along the periphery of the artery, and bands or webs. Secondary findings of pulmonary artery hypertension manifest as enlargement of the main pulmonary arteryMGH Cardiovascular Images. 05/2014; 1(61):1.