Prognostic value of CT pulmonary angiography parameters in acute pulmonary embolism

• DOI: 10.1007/s11547-021-01364-6
• Publication Date: 2021-05-07T10:03:20Z
• Authors: Diletta Cozzi; Chiara Moroni; Edoardo Cavigli; Alessandra Bindi; Cosimo Caviglioli; Peiman Nazerian; Simone Vanni; Vittorio Miele; Maurizio Bartolucci
• Keywords: Adult; Aged, 80 and over; Male; Time Factors; Adolescent; Computed Tomography Angiography; Middle Aged; Prognosis; Pulmonary embolism · Prognosis · Computed tomography · Emergency treatment; 3. Good health; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Predictive Value of Tests; Acute Disease; Humans; Female; Correlation of Data; Pulmonary Embolism; Aged; Retrospective Studies

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.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.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.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.