Severe pulmonary embolism:pulmonary artery clot load scores and cardiovascular parameters as predictors of mortality.
OBJECTIVE
To retrospectively evaluate pulmonary artery (PA) clot load scores and computed tomographic (CT) cardiovascular parameters as predictors of mortality in patients with severe pulmonary embolism (PE).


METHODS
Institutional review board approval was obtained with waiver of informed consent. A total of 82 consecutive patients (42 women, 40 men; mean age+/-standard deviation, 61 years+/-15) were admitted to the intensive care unit for PE-related conditions and were evaluated by using CT pulmonary angiography. Two independent readers who were blinded to clinical outcome quantified PA clot load by using four scoring systems. Cardiovascular measurements included right ventricular (RV) and left ventricular (LV) short-axis measurements; RV short axis to LV short axis (RV/LV) ratios; main PA, ascending aorta, azygos vein, and superior vena cava diameters; and main PA diameter to aorta diameter ratios. Reflux of contrast medium into the inferior vena cava, leftward bowing of the interventricular septum, pleural or pericardial effusion, pulmonary consolidation, infarct, platelike atelectasis, and mosaic ground-glass opacity were also recorded. Results were correlated with patient outcome during hospital stay by using the Wilcoxon rank sum and chi2 tests.


RESULTS
Twelve patients died within 1-14 days. RV and LV short axis; RV/LV ratio; azygos vein, superior vena cava, and aorta diameters; and contrast medium reflux into the inferior vena cava were significantly different between survivors and nonsurvivors (P<.05). No significant relationship was found between PA clot load and mortality rate. RV/LV ratio and azygos vein diameter allowed correct prediction of survival in 89% of patients (P<.001).


CONCLUSIONS
RV/LV ratio and azygos vein diameter are predictors of mortality in patients with severe PE.
Ghaye
Benoit
B
Department of Medical Imaging and Medicine, University Hospital of Liege, B35 Sart Tilman, B-4000 Liege, Belgium. bghaye@chu.ulg.ac.be
Ghuysen
Alexandre
A
Willems
Valerie
V
Lambermont
Bernard
B
Gerard
Paul
P
D'Orio
Vincent
V
Gevenois
Pierre Alain
PA
Dondelinger
Robert F
RF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001027:Aortography; D001401:Azygos Vein / Q000000981:diagnostic imaging; D002423:Cause of Death; D003287:Contrast Media; D005260:Female; D005544:Forecasting; D006346:Heart Septum / Q000000981:diagnostic imaging; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000000981:diagnostic imaging; D010996:Pleural Effusion / Q000000981:diagnostic imaging; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000145:classification / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging
D003287:Contrast Media