Widening of coronary sinus in CT pulmonary angiography indicates right ventricular dysfunction in patients with acute pulmonary embolism.
OBJECTIVE
Right ventricular dysfunction (RVD) may occur in the course of acute pulmonary embolism (PE). Patients with RVD need more intensive treatment, and the prognosis is more severe. The aim of this study was to evaluate the usefulness of the measurement of the coronary sinus in the assessment of RVD in patients with acute PE and to compare it with other indicators of RVD.


METHODS
Retrospective assessment of 55 CT pulmonary angiography examinations with signs of acute PE was performed. Pulmonary artery systolic pressure (PASP) was echocardiographically assessed in all patients, and RVD was defined as PASP values greater than 30 mmHg. CT measurements included the size of the heart ventricles, mediastinal vessels and the width of the coronary sinus.


RESULTS
Median width of the coronary sinus was 16 mm (range 12-24 mm) in patients with increased PASP and 10 mm (range 7-22 mm) in patients with normal PASP (p = 0.001). Best cut-off value was assessed to be 12.5 mm, with sensitivity 94% and specificity 75%. It was characterised by the largest area under ROC curve (0.82) among analysed parameters.


CONCLUSIONS
Width of the coronary sinus seems to be a promising parameter for identification of RVD in patients with acute PE. A prospective study should be undertaken to further assess its clinical and prognostic applicability.
Staskiewicz
Grzegorz
G
1st Department of Radiology, Medical University of Lublin, Lublin, Poland. grzegorz.staskiewicz@umlub.pl
Czekajska-Chehab
Elzbieta
E
Przegalinski
Jerzy
J
Tomaszewski
Andrzej
A
Torres
Kamil
K
Torres
Anna
A
Trojanowska
Agnieszka
A
Maciejewski
Ryszard
R
Drop
Andrzej
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D054326:Coronary Sinus / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications* / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000000981:diagnostic imaging*; D055815:Young Adult