title: Multidetector computed tomography for acute pulmonary embolism: diagnosis and risk stratification in a single test.
abstract: OBJECTIVE
  In patients with acute pulmonary embolism (PE), right ventricular dysfunction at echocardiography is associated with increased in-hospital mortality. The aims of this study in patients with acute PE were to identify a sensitive and simple criterion for right ventricular dysfunction at multidetector computed tomography (MDCT) using echocardiography as the reference standard and to evaluate the predictive value of the identified MDCT criterion for in-hospital death or clinical deterioration.
  
  
  RESULTS
  Right ventricular dysfunction at MDCT was defined as the right-to-left ventricular dimensional ratio and was centrally assessed by a panel unaware of clinical and echocardiographic data. A right-to-left ventricular dimensional ratio ≥0.9 at MDCT had a 92% sensitivity for right ventricular dysfunction [95% confidence interval (CI) 88-96]. Overall, 457 patients were included in the outcome study: 303 had right ventricular dysfunction at MDCT. In-hospital death or clinical deterioration occurred in 44 patients with and in 8 patients without right ventricular dysfunction at MDCT (14.5 vs. 5.2%; P< 0.004). The negative predictive value of right ventricular dysfunction for death due to PE was 100% (95% CI 98-100). Right ventricular dysfunction at MDCT was an independent predictor for in-hospital death or clinical deterioration in the overall population [hazard ratio (HR) 3.5, 95% CI 1.6-7.7; P= 0.002] and in haemodynamically stable patients (HR 3.8, 95% CI 1.3-10.9; P= 0.007).
  
  
  CONCLUSIONS
  In patients with acute PE, MDCT might be used as a single procedure for diagnosis and risk stratification. Patients without right ventricular dysfunction at MDCT have a low risk of in-hospital adverse outcome.
authors.affiliation: Stroke Unit, Department of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy. cecilia.becattini@unipg.it
authors.forename: Cecilia
authors.initials: C
authors.lastname: Becattini
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Vedovati
authors.forename: Piotr
authors.initials: P
authors.lastname: Pruszczyk
authors.forename: Franco
authors.initials: F
authors.lastname: Casazza
authors.forename: Stefano
authors.initials: S
authors.lastname: Grifoni
authors.forename: Aldo
authors.initials: A
authors.lastname: Salvi
authors.forename: Marina
authors.initials: M
authors.lastname: Bianchi
authors.forename: Renée
authors.initials: R
authors.lastname: Douma
authors.forename: Stavros
authors.initials: S
authors.lastname: Konstantinides
authors.forename: Mareike
authors.initials: M
authors.lastname: Lankeit
authors.forename: Michele
authors.initials: M
authors.lastname: Duranti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000592:standards*; D015588:Observer Variation; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000401:mortality; D012372:ROC Curve; D012015:Reference Standards; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000401:mortality; D055815:Young Adult