Bruce A. Gardner MD, Presenter: Nothing to Disclose

Michael F. Morris MD, Abstract Co-Author: Nothing to Disclose

Michael Bruce Gotway MD, Abstract Co-Author: Nothing to Disclose

Kristine M. Thomsen BS, Abstract Co-Author: Nothing to Disclose

Philip A. Araoz MD, Abstract Co-Author: Consultant, Medtronic, Inc, Mounds View, MN

To retrospectively determine whether CT findings of RV/LV ratio, ventricular septal bowing, and embolic load are predictors of long-term all cause mortality in patients with CT for PE, using multivariate analysis to account for clinical risk factors.

Between January 1, 1997 and December 31, 2002, 1105 patients with CT positive for PE were identified. Two radiologists reviewed the CT scans for embolic load, RV/LV diameter ratio, and septal bowing. Charts were reviewed for age, sex, and 13 comorbid conditions, including congestive heart failure, ischemic heart disease, pulmonary disease, malignancy, type of treatment, and others. Charts were reviewed for all cause mortality. A follow-up search of the Accurint database (LexisNexis Risk Solutions, St. Cloud, MN) was performed to capture any additional deaths in those patients without documented death in the medical record. Univariate and multivariate logistic regression was used to determine the incremental prognostic value of CT findings over clinical information and Kaplan-Meier survival curves were generated.

The mean age was 63 ±16.0 years. 515 (46.6%) were female. There were a total of 580 deaths (53%) from all causes, with a median survival of 6.2 years following CT. For the remaining 525 patients, a mean of 6.5 years transpired between the date of CT and the last documented follow-up. Increasing embolic load was associated with increased long-term survival in univariate and multivariate models (hazard ratio = 0.97, p < 0.001 for death for both). RV/LV diameter ratio, and septal bowing were not associated with long term survival in either univariate and multivariate models.

Increasing embolic load is not associated with decreased long-term survival and was actually associated with increased survival, even after extensive accounting of comorbid conditions and treatment. Patients with large emboli who survive to obtain CT scanning may have characteristics which separate them other patients with CT positive for PE.

Aggressive treatment in PE is not warranted based on embolic load alone.

Gardner, B, Morris, M, Gotway, M, Thomsen, K, Araoz, P, Increased Embolic Load Is Associated with Increased Long Term Survival in CT for Pulmonary Embolism.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9007223.html