Juana Maria Plasencia-Martinez MD, Presenter: Nothing to Disclose

David Calvo-Temprano MD, Abstract Co-Author: Nothing to Disclose

Alberto Carmona-Bayonas MD, Abstract Co-Author: Nothing to Disclose

Carme Font MD, Abstract Co-Author: Nothing to Disclose

Paula Jimenez-Fonseca MD, Abstract Co-Author: Nothing to Disclose

Alejandro Puerta MD, Abstract Co-Author: Nothing to Disclose

Angel Dominguez-Perez, Abstract Co-Author: Nothing to Disclose

Pedro Arguis MD, Abstract Co-Author: Nothing to Disclose

Mariana Nelida Benegas Urteaga MD, Abstract Co-Author: Nothing to Disclose

Susana Hernandez Muniz MD, Abstract Co-Author: Nothing to Disclose

Carmen Beato MD, Abstract Co-Author: Nothing to Disclose

Angeles Vicente MD, Abstract Co-Author: Nothing to Disclose

Merce Biosca MD, Abstract Co-Author: Nothing to Disclose

Olga Madriano MD, Abstract Co-Author: Nothing to Disclose

To assess the correlation between embolic burden, right ventricular overload and clinical outcomes in cancer-related pulmonary embolism (PE).

EPIPHANY is an observational, multicenter study that recruits consecutive cases of cancer-related PE, including both incidental (detected by CT with conventional iv contrast) and acute symptomatic events (CT pulmonary angiography [CTPA] in patients with symptoms). The embolic burden was assessed by the Qanadli obstruction index (QI), and the location of PEs (main pulmonary artery, lobar vs. segmental and subsegmental). We also measured the right ventricular-left ventricular (RV-LV) diameter ratio, the displacement (inversion or flattening) of the interventricular septum (IVS), the type of diagnosis (incidental vs. symptomatic), systolic blood pressure (SBP), pulse oxymetry, the European Cooperative Group (ECOG) performance status and TNM stage. The main outcome measure was the presence of symptoms and 30-day mortality.

208 patients were included in the study (male 48%, mean age 64.8 years). The rate of incidental and normotensive (≥90 mmHg) PEs was 49% and 90%, respectively. The 30-day mortality rate was 21% (95% CI, 15.4-26.5%). An abnormal IVS predicted mortality with an odds ratio of 2.6 (95% CI, 1-7), even after adjustment for clinical characteristics. In the subgroup of normotensive patients, the mortality was higher in patients with an IVS anomaly (31% vs. 18%, p=0.07). The RV-LV ratio was slightly correlated with SBP at first assessment (r=-0.147, p=0.03), but was not a predictor of death. In the subgroup of symptomatic PEs diagnosed by CTPA, the QI was slightly correlated with oxymetry (r=-0.223, p=0.02) but not SBP. With a cut-off of 40%, the QI was not associated with prognosis. Of note, a central location of PEs was not associated with either PE-symptoms, such as dyspnea, or with clinical outcome. 

A flattening or inversion of the IVS is an independent risk factor of early mortality in patients with cancer-related PE. The discriminatory ability of the QI and the RV-LV ratio was low in this population.

An abnormal interventricular septum assessed by chest CT can predict the short-term survival of patients with cancer-related pulmonary embolism and should be reported regardless of the embolic burden.

Plasencia-Martinez, J, Calvo-Temprano, D, Carmona-Bayonas, A, Font, C, Jimenez-Fonseca, P, Puerta, A, Dominguez-Perez, A, Arguis, P, Benegas Urteaga, M, Hernandez Muniz, S, Beato, C, Vicente, A, Biosca, M, Madriano, O, Predictive Value of Embolic Burden and Right Ventricular Dysfunction Signs Assessed by Computed Tomography in Cancer-related Pulmonary Embolism: Data on 208 Consecutive Patients from the EPIPHANY Study.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14005734.html