Alessandro Furlan MD, Presenter: Nothing to Disclose

Ayaz Aghayev MD, Abstract Co-Author: Nothing to Disclose

Amol Patil, Abstract Co-Author: Nothing to Disclose

Chung-Chou H. Chang, Abstract Co-Author: Nothing to Disclose

Bum-Woo Park, Abstract Co-Author: Nothing to Disclose

Kyongtae Tyler Bae MD, PhD, Abstract Co-Author: Patent agreement, Covidien AG Patent agreement, Bayer AG Expert Advisory Committee, Bracco Group

To determine whether CT pulmonary angiography (CTPA) imaging signs of right heart dysfunction as well as measures of clot burden including blood clot volume, could predict short-term mortality in patients with acute pulmonary embolism (PE).

This HIPAA-compliant retrospective study was approved by the IRB. CTPA studies reported positive for PE and performed between January and December 2007 were retrieved. Patient’s demographics, co-morbidities, and short-term mortality (i.e. in-hospital death, or death within 30 days due to PE) information were obtained. Two readers evaluated CT signs of right heart dysfunction and measured clot burden using semi-quantitative scores and direct quantification of clot volume using a dedicated software program. Uni- and multivariable analysis was used to test the association between CTPA imaging findings and short-term mortality.

635 CTPA studies from 635 patients (304M, 331F, mean age: 59 years) were included. Thirty-nine (6%) patients died within 30-days of presentation. Among the CT signs considered: right over left heart ventricle (RV/LV) diameter ratio; main pulmonary artery over ascending aorta (PA/Ao) diameter ratio; flattening and bowing of interventricular septum; and presence of contrast reflux into inferior vena cava, were associated with short-term mortality in the univariable analysis. However, only the increase in RV/LV diameter ratio (cut-off value, 1.0) was independently associated with short-term mortality in multivariable analysis.

Increased RV/LV diameter ratio was associated with higher risk for short-term mortality in patients with acute PE at CTPA. Measures of clot burden did not demonstrate a statistically significant association with short-term mortality.

Among the considered CTPA imaging biomarkers, RV/LV diameter ratio larger than 1.0 was the strongest predictor of short term mortality in patients with acute PE.

Furlan, A, Aghayev, A, Patil, A, Chang, C, Park, B, Bae, K, CT Pulmonary Angiography Imaging Features Associated with Short-term Mortality in Acute Pulmonary Embolism.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11009673.html