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Decreased pulmonary artery distensibility as a marker for severity in acute pulmonary embolism patients undergoing ECG-gated CTPA

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Abstract

To investigate the characteristics of pulmonary artery distensibility (PAD) in patients with acute pulmonary embolism (APE) and to assess whether a relationship exists between PAD and the disease severity. Clinical and radiological data of 30 APE patients who underwent retrospective electrocardiogram (ECG)-gated computed tomography pulmonary angiography (CTPA) with a definite diagnosis of APE were retrospectively reviewed in the present study, including 15 subjects in severe (SPE) group and 15 subjects in non-severe (NSPE) group. PAD and cardiac function parameters were compared between the two groups, their relationships were investigated, and receiver operating characteristic (ROC) curves were used to determine the sensitivity and specificity of the above parameters for the diagnosis of APE severity. The PAD decreased in the following order: NSPE group (6.065 ± 2.114) × 10−3 (%/mmHg), and SPE group (4.334 ± 1.777) × 10−3 (%/mmHg) (P < 0.05). All the cardiac function parameters except RA/LAdiameter showed statistically significant different values between the two groups (P < 0.05). As APE severity increased, the cardiac morphological measurements of RV/LVdiameter, RV/LVarea, RVEDV/LVEDV and RVESV/LVESV increased. There was a weak to moderate negative correlation between PAD and PAmax, PAmin, PA/AAmin, PA/AAmax, RV/LVdiameter, RV/LVarea (r = −0.393 to −0.625), that is, PAD was inversely correlated with cardiac function parameters. There was a moderate negative correlation between PAD and hemoptysis(r = −0.672). The area under the ROC curve (AUC) of PAD was 0.724, the critical value was 4.137 × 10−3  mm/Hg, and the sensitivity and specificity were 60.0% and 93.3%, respectively. PAmin showed the strongest discriminatory power to identify high-risk patients (AUC = 0.827), with the highest sensitivity of 100%, which was also achieved by RA/LAarea. The PAD obtained by retrospective ECG-gated CTPA could be an indicator to be used in the evaluation of the presence and severity of APE.

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Abbreviations

AUC:

Area under the curve

LVEDV:

Left ventricular end-diastolic volume

LVESV:

Left ventricular end-systolic volume

NSPE:

Non-severe pulmonary embolism

PAmax:

Maximum cross-sectional area of PA

PAmin:

Minimum cross-sectional area of PA

PA/AAmax:

Ratio of the maximum cross-sectional area of PA and AA

PA/AAmin:

Ratio of the minimum cross-sectional area of PA and AA

PAD:

Pulmonary artery distensibility

ROC:

Receiver operating characteristic

RA/LAdiameter:

Diameter ratio of RA/LA

RA/LAarea:

Area ratio of RA/LA

RV/LVdiameter:

Diameter ratio of RV/LV

RV/LVarea:

Area ratio of RV/LV

RVEDV:

Right ventricular end-diastolic volume

RVESV:

Right ventricular end-systolic volume

SPE:

Severe pulmonary embolism

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Funding

Planning Project of Medical Scientific Research of Hebei. Grant/Award Number: 20180838.

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Authors and Affiliations

  1. Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China

    Fei Yang, Shujun Cui, Yuexiang Zhu, Lan Liu, Mengmeng Ji, Dianjun Zou, Ru Zhao & Qingxiao Liu

  2. Department of Thoracic Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China

    Dawei Wang

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  1. Fei Yang
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  2. Dawei Wang
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  4. Yuexiang Zhu
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  5. Lan Liu
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  7. Dianjun Zou
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  8. Ru Zhao
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  9. Qingxiao Liu
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Contributions

(1) Conceptualization, Writing (review/editing), Funding acquisition: FY; (2) Writing (original draft): DW; (3) Project administration: SC; (4) Supervision: YZ; (5) Software: LL; (6) Formal analysis: MJ; (7) Data curation: DZ; (8) Investigation: RZ; (9)Validation:QL.

Corresponding author

Correspondence to Fei Yang.

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Conflict of interest

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Ethical approval

The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was approved by the First Affiliated Hospital of Hebei North University Ethics Committee (IRB2018133).

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Yang, F., Wang, D., Cui, S. et al. Decreased pulmonary artery distensibility as a marker for severity in acute pulmonary embolism patients undergoing ECG-gated CTPA. J Thromb Thrombolysis 51, 748–756 (2021). https://doi.org/10.1007/s11239-021-02397-4

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  • DOI: https://doi.org/10.1007/s11239-021-02397-4

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