Abstract 1780: Estimation of Right Ventricular Dysfunction and Risk Stratification Using Chest Computed Tomography in Acute Pulmonary Embolism
Background: Acute pulmonary embolism is a life threatening disease. Rapid diagnosis and clinical decision is mandatory to discriminate the high risk patients. Right ventricular (RV) dysfunction according to the acute pressure overload is an important risk factor in pulmonary embolism, and secondary change such as RV dilatation or septal flattening of left ventricle is commonly accompanied. Computed tomography (CT) is the most commonly used diagnostic tool in pulmonary embolism, and sometimes more rapidly available than echocardiography in emergency room. It also gives information about the cardiac morphology. We hypothesized that chest CT to diagnose the pulmonary embolism can also give rapid approach to the RV dysfunction in emergency room.
Methods and Results: We reviewed 121 patients diagnosed as acute pulmonary embolism by chest helical CT from 2004 to 2008. We defined poor outcome as a least one of following: death associated embolism in 30 days, cardiopulmonary resuscitation, use of inotropics due to hypotension, mechanical ventilation, and thrombolysis or surgical embolectomy. Among them, 83(68.6%) patients had taken echocardiography and 70(57.9%) patients had RV hypokinesia. Chest CT was reviewed and RV to LV diameter ratio (RVd/LVd), septal straitening and location of embolism were evaluated. RV hypokiesia in echocardiography was significantly associated with RVd/LVd (p<0.001), septal straitening (p<0.001) and proximal location of embolism (p=0.014). The odds ratio (OR) of RV hypokinesia in echocardiography for poor outcomes was 10.5 (p<0.001). The OR of RVd/LVd >1 by CT was 21 (p<0.001). In the hemodynamically stable patients with systolic blood pressure>90 mmHg, OR for poor outcomes in the patients with RV/LV >1 was 16.7 (p>0.001). In hemodynamically stable group, presence of both RVd/LVd >1 with septal straitening and proximal location of pulmonary embolus predicts poor clinical outcomes (positive predictive value 56.5%, negative predictive value 93.7%, sensitivity 78.3%, and specificity 84.1%).
Conclusions CT parameters are well correlated with RV dysfunction and associated with poor outcomes in acute pulmonary embolism. Rapid risk stratification of pulmonary embolism patients may be possible based on chest CT.