title: Usefulness of computed tomographic pulmonary angiography in the risk stratification of acute pulmonary thromboembolism. Comparison with cardiac biomarkers.
abstract: BACKGROUND
  To evaluate the usefulness of computed tomographic pulmonary angiographic (CTPA) variables in the risk stratification of acute pulmonary thromboembolism (APE) and compare these variables with cardiac biomarkers.
  
  
  RESULTS
  Eighty consecutive patients with APE were divided into patients with right ventricular (RV) dysfunction (n=49, 62.1±15.1 years, 31 females) vs. patients without RV dysfunction (n=31, 67.7±13.7 years, 18 females). CTPA variables were analyzed and compared with cardiac biomarkers. The ratio of right to left ventricular dimension (RVD/LVD), CT index of PA clot load, contrast reflux to the inferior vena cava (IVC), and ventricular septal bowing (VSB) were significantly different CTPA variables between the groups. These variables were also significantly associated with cardiac biomarkers. By receiver operation characteristic curve analysis, the area under the curve to predict RV dysfunction was 0.863 for RVD/LVD, 0.841 for PA clot load, 0.744 for contrast reflux to IVC, and 0.635 for VSB. The optimal cut-off value to predict RV dysfunction was 1.12 for RVD/LVD (sensitivity: 89.8%, specificity: 77.4%) and 19.5 for PA clot load (sensitivity: 81.6%, specificity: 77.4%).
  
  
  CONCLUSIONS
  RVD/LVD, PA clot load, contrast reflux to IVC, and VSB on CTPA were significantly associated with RV dysfunction and cardiac biomarkers in APE. The present study demonstrated that CTPA is useful not only in the diagnosis, but also in the risk stratification of APE.
authors.affiliation: Department of Radiology, Chonnam National University Hospital, The Research Institute of Medical Sciences of Chonnam National University, Gwangju, South Korea.
authors.forename: Hyun Ju
authors.initials: HJ
authors.lastname: Seon
authors.forename: Kye Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Woo Seok
authors.initials: WS
authors.lastname: Lee
authors.forename: Song
authors.initials: S
authors.lastname: Choi
authors.forename: Hyun Ju
authors.initials: HJ
authors.lastname: Yoon
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.forename: Yun-Hyeon
authors.initials: YH
authors.lastname: Kim
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Jeong Gwan
authors.initials: JG
authors.lastname: Cho
authors.forename: Jong Chun
authors.initials: JC
authors.lastname: Park
authors.forename: Jung Chaee
authors.initials: JC
authors.lastname: Kang
mesh_terms: D000368:Aged; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011655:Pulmonary Embolism / Q000097:blood / Q000000981:diagnostic imaging* / Q000453:epidemiology; D012189:Retrospective Studies; D012306:Risk; D012680:Sensitivity and Specificity; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality; D016037:Single-Blind Method; D036542:Tomography, Spiral Computed; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood; D018497:Ventricular Dysfunction, Right / Q000097:blood / Q000000981:diagnostic imaging
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D019210:Troponin I; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein