title: Assessment of right ventricular function in acute pulmonary embolism using ECG-synchronized MDCT.
abstract: OBJECTIVE
  The purpose of this article is to determine the independent predictors of right ventricular (RV) dysfunction in patients with acute pulmonary embolism (PE) and to assess the relationship between RV ejection fraction (EF) and PE load.
  
  
  METHODS
  Breath-hold CT of the chest was performed for 64 patients with PE (33 men and 31 women; mean [± SD] age, 58.6 ± 16.5 years). In addition, ECG-synchronized cardiac CT was performed to determine the RV and left ventricular (LV) EFs. PE load was determined using the Qanadli obstruction index. Multivariable regression analysis was performed to determine independent predictors of RV dysfunction (defined as EF < 35%). In addition, the relationship between RV EF and PE load was assessed by receiver operating characteristic (ROC) curves.
  
  
  RESULTS
  RV dysfunction was independently predicted by a PE load greater than 50% (odds ratio, 40.17; 95% CI, 4.22-382.67) and an LV EF less than 45% (odds ratio, 31.18; 95% CI, 2.00-487.09; p < 0.05 for both). Curve analysis revealed that a PE load greater than 50% had a sensitivity of 82% and a specificity of 85% to identify an RV EF less than 35%. Conversely, an RV EF less than 35% had a sensitivity of 93% and a specificity of 67% to predict a PE load greater than 50%.
  
  
  CONCLUSIONS
  RV dysfunction (defined as RV EF < 35%) in patients with acute PE is highly sensitive to define a PE load greater than 50%. Furthermore, RV dysfunction is independently predicted by an obstruction index greater than 50% or an LV EF less than 45%. Assessment of RV function by ECG-synchronized CT may become useful for guiding therapy.
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands.
authors.forename: Halil
authors.initials: H
authors.lastname: Dogan
authors.forename: Lucia J M
authors.initials: LJ
authors.lastname: Kroft
authors.forename: Menno V
authors.initials: MV
authors.lastname: Huisman
authors.forename: Rob
authors.initials: R
authors.lastname: van der Geest
authors.forename: Ying
authors.initials: Y
authors.lastname: Li O
authors.forename: Hildo J
authors.initials: HJ
authors.lastname: Lamb
authors.forename: Albert
authors.initials: A
authors.lastname: de Roos
mesh_terms: D000208:Acute Disease; D000368:Aged; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications*; D014057:Tomography, X-Ray Computed / Q000379:methods; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000209:etiology*