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Prognostic value of CT pulmonary angiography parameters in acute pulmonary embolism

  • Chest Radiology
  • Published:
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Abstract

Objectives

Computed tomographic pulmonary angiography (CTPA) is the first-line test in acute pulmonary embolism (APE) diagnostic algorithm, but its correlation with short-term outcome remains not clear at all. The aim is to determine whether CTPA findings can predict 30-day mortality of patients with APE in Emergency Department.

Methods

This retrospective monocentric study involved 780 patients with APE diagnosed at the Emergency Department of our institution (period 2010–2019). These CTPA findings were evaluated: embolic obstruction burden score (Qanadli score), common pulmonary artery trunk diameter, right-to-left ventricular ratio, azygos vein and coronary sinus diameters. Comorbidities and fatal/nonfatal adverse outcomes within 30 days were recorded. Troponin I values were correlated with angiographic parameters with multiple logistic regression analysis.

Results

The all-cause and APE-related 30-day mortality rates were 5.9% and 3.6%, respectively. Patients who died within 30 days were older with higher prevalence rates of malignancy. Qanadli score and all CTPA parameters correlate with Troponin I level and the presence of RVD at echocardiography (p values < 0.0001). Instead, RV/LV ratio and coronary sinus diameter correlate with 30-day mortality (p values < 0.05). At the multivariate logistic regression analysis, only coronary sinus and RVD remained significant with an HR = 2.5 (95% CI 1.1–5.6) and HR = 1.9 (95% CI 0.95–3.7), respectively.

Conclusion

CTPA quantification of right ventricular strain is an accurate predictor of 30-day mortality. In particular, it seems that a dilated coronary sinus (>9 mm) has an additional prognostic value in association with echocardiographic signs of right-heart disfunction and high Troponin I levels.

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Abbreviations

APE:

Acute pulmonary embolism

ED:

Emergency department

RVD:

Right ventricular dysfunction

CTPA:

Computed tomographic pulmonary angiography

SD:

Standard deviation

HR:

Hazard ratio

RV/LV:

Right ventricle-to-left ventricle ratio

CTEPH:

Chronic thromboembolic pulmonary hypertension

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Acknowledgements

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Authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Emergency Radiology, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy

    Diletta Cozzi, Chiara Moroni, Edoardo Cavigli, Alessandra Bindi & Vittorio Miele

  2. Department of Emergency Medicine, Careggi University Hospital, Florence, Italy

    Cosimo Caviglioli & Peiman Nazerian

  3. Department of Emergency Medicine, San Giuseppe Hospital, Empoli, Italy

    Simone Vanni

  4. Department of Radiology, Santo Stefano Hospital, Prato, Italy

    Maurizio Bartolucci

Authors
  1. Diletta Cozzi
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  2. Chiara Moroni
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  3. Edoardo Cavigli
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  4. Alessandra Bindi
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  5. Cosimo Caviglioli
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  7. Simone Vanni
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  8. Vittorio Miele
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  9. Maurizio Bartolucci
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Contributions

DC, CM, EC and AB contributed to radiological data evaluation and manuscript editing. SV performed statistical analysis; CC and PN were involved in patients collection. VM and MB contributed to final approval.

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Correspondence to Diletta Cozzi.

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The authors declare that they have no conflict of interest related to the publication of this article.

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All procedures in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics Committee of our University Hospital (ref. 15671_oss).

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Cozzi, D., Moroni, C., Cavigli, E. et al. Prognostic value of CT pulmonary angiography parameters in acute pulmonary embolism. Radiol med 126, 1030–1036 (2021). https://doi.org/10.1007/s11547-021-01364-6

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  • DOI: https://doi.org/10.1007/s11547-021-01364-6

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