Chest CT Parameters to Predict the Major Adverse Events in Acute Submassive Pulmonary Embolism.

Jung, Sang Ku; Kim, Won Young; Lee, Choong Wook; Seo, Dong Woo; Lee, Youn Sun; Lee, Jae Ho; Oh, Bum Jin; Kim, Won; Lim, Kyoung Soo; Hong, Sang Bum; Lim, Chae Man; Koh, Younsuck

doi:2010.69.3.184

Tuberc Respir Dis > Volume 69(3); 2010 > Article

Original Article

Tuberculosis and Respiratory Diseases 2010;69(3):184-190.
DOI: https://doi.org/10.4046/trd.2010.69.3.184 Published online September 1, 2010.

Chest CT Parameters to Predict the Major Adverse Events in Acute Submassive Pulmonary Embolism.

Sang Ku Jung, Won Young Kim, Choong Wook Lee, Dong Woo Seo, Youn Sun Lee, Jae Ho Lee, Bum Jin Oh, Won Kim, Kyoung Soo Lim, Sang Bum Hong, Chae Man Lim, Younsuck Koh

¹Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. wonpia@yahoo.co.kr
²Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
³Department of Respiratory and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

BACKGROUND
The purpose of this study was to determine the prognostic significance of chest computed tomographic (CT) parameters in acute submassive pulmonary embolism (PE). METHODS: Between January 2006 and December 2009, 268 consecutive patients with acute submassive PE that was confirmed by chest CT with pulmonary angiography in emergency room were studied. One experienced radiologist measured CT parameters and judged the presence of right ventricular dysfunction. CT parameters were analyzed to determine their ability to predict a major adverse event (MAE). RESULTS: There were 220 patients included and 61 (27.7%) had MAE. Left ventricular and right ventricular maximum minor axis (36.4+/-8.0 vs. 41.7+/-7.4, p<0.01; 45.7+/-9.4 vs. 41.5+/-7.6, p<0.01), superior vena cava diameter (19.2+/-3.4 vs. 18.0+/-3.4, p=0.02), azygos vein diameter (10.0+/-2.2 vs. 9.2+/-2.3, p=0.02), septal displacement (19 vs. 18, p<0.01) were significantly higher in MAE group than in no MAE group. Patients with MAE had high right ventricular/left ventricular dimension ratio (RV/LV ratio) compared to patients without MAE (1.34+/-0.48 vs. 1.03+/-0.28, p<0.01). The most useful cut-off value of RV/LV ratio for MAE was 1.3 and the area under the curve was 0.71 (0.62~0.79). CONCLUSION: RV/LV ratio on chest CT was a significant predictor of submassive PE related shock, intubation, in-hospital mortality, thrombolysis, thrombectomy within 30 days.

Key Words: Pulmonary Embolism, Tomography, Prognosis