TY - JOUR
T1 - Prognostic value of cardiovascular parameters in computed tomography pulmonary angiography in patients with acute pulmonary embolism
AU - Beenen, Ludo F. M.
AU - Bossuyt, Patrick M. M.
AU - Stoker, Jaap
AU - Middeldorp, Saskia
PY - 2018
Y1 - 2018
N2 - The value of various computed tomography parameters for prognosis and risk stratification in acute pulmonary embolism is controversial. Our objective was to evaluate the impact of specific cardiovascular computed tomography pulmonary angiography parameters on short- and long-term clinical outcomes. We analysed radiological and clinical data of 1950 patients with acute pulmonary embolism who participated in an international randomised clinical trial on anticoagulants. Parameters included right/left ventricular ratio, septal bowing, cardiothoracic ratio, diameters of pulmonary trunk and aorta, and intrahepatic/azygos vein contrast medium backflow. Associations with mortality, recurrent venous thromboembolism (VTE), hospitalisation, bleeding and adverse events were assessed over the short term (1 week and 1 month) and long term (12 months). Pulmonary trunk enlargement was the only parameter significantly associated with mortality over both the short and long term (OR 4.18 (95% CI 1.04-16.76) at 1 week to OR 2.33 (95% CI 1.36-3.97) after 1 year), as well as with recurrent VTE and hospitalisation. Most of the evaluated radiological parameters do not have strong effects on the short- or long-term outcome in patients with acute pulmonary embolism. Only an enlarged pulmonary trunk diameter carries an increased risk of mortality and recurrent VTE up to 12 months, and can be used for risk stratification.
AB - The value of various computed tomography parameters for prognosis and risk stratification in acute pulmonary embolism is controversial. Our objective was to evaluate the impact of specific cardiovascular computed tomography pulmonary angiography parameters on short- and long-term clinical outcomes. We analysed radiological and clinical data of 1950 patients with acute pulmonary embolism who participated in an international randomised clinical trial on anticoagulants. Parameters included right/left ventricular ratio, septal bowing, cardiothoracic ratio, diameters of pulmonary trunk and aorta, and intrahepatic/azygos vein contrast medium backflow. Associations with mortality, recurrent venous thromboembolism (VTE), hospitalisation, bleeding and adverse events were assessed over the short term (1 week and 1 month) and long term (12 months). Pulmonary trunk enlargement was the only parameter significantly associated with mortality over both the short and long term (OR 4.18 (95% CI 1.04-16.76) at 1 week to OR 2.33 (95% CI 1.36-3.97) after 1 year), as well as with recurrent VTE and hospitalisation. Most of the evaluated radiological parameters do not have strong effects on the short- or long-term outcome in patients with acute pulmonary embolism. Only an enlarged pulmonary trunk diameter carries an increased risk of mortality and recurrent VTE up to 12 months, and can be used for risk stratification.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85049638264&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29773691
U2 - https://doi.org/10.1183/13993003.02611-2017
DO - https://doi.org/10.1183/13993003.02611-2017
M3 - Article
C2 - 29773691
SN - 0903-1936
VL - 52
JO - European respiratory journal
JF - European respiratory journal
IS - 1
M1 - 1702611
ER -