title: Evaluation of right ventricular dysfunction and prediction of clinical outcomes in acute pulmonary embolism by chest computed tomography: comparisons with echocardiography.
abstract: To evaluate the ability to identify right ventricular (RV) dysfunction, and to predict adverse outcomes of chest computed tomography (CT), we compared CT and echocardiography in acute pulmonary embolism patients. We analyzed 56 patients diagnosed by CT with acute pulmonary embolism, who underwent echocardiography within 48 h of CT scan from January 2004 to December 2008. From the CT scan, the ratio of RV diameter to left ventricular diameter (RVd/LVd), the presence of septal bowing and embolus location were determined. RVd/LVd (P < 0.001), septal bowing (P < 0.001) and proximal embolism (P = 0.016) were associated with echocardiographic RV hypokinesia. The odds ratio for adverse clinical outcomes was 19.2 for the combination of three CT parameters (RVd/LVd > 1, septal bowing, and proximal embolism), and 13.4 for RV hypokinesia (each P = 0.001). The positive predictive value (PPV) for adverse clinical outcomes for echocardiographic RV hypokinesia was 55.0%, and the negative predictive value (NPV) was 96.2%. The three-parameter combination predicted adverse clinical outcomes with a PPV of 54.5%, and a NPV of 94.1%. CT parameters including RV dysfunction were significantly associated with poor outcomes. Rapid risk stratification of patients with acute pulmonary embolism based on chest CT appears to be comparable with echocardiography, is clinically reliable, and may be useful in guiding management strategy.
authors: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea.
authors: Jeong Rang
authors: JR
authors: Park
authors: Sung-A
authors: SA
authors: Chang
authors: Shin Yi
authors: SY
authors: Jang
authors: Hye Jin
authors: HJ
authors: No
authors: Sung-Ji
authors: SJ
authors: Park
authors: Seung-Hyuk
authors: SH
authors: Choi
authors: Seung Woo
authors: SW
authors: Park
authors: Hojoong
authors: H
authors: Kim
authors: Yeon Hyeon
authors: YH
authors: Choe
authors: Kyung Soo
authors: KS
authors: Lee
authors: Jae K
authors: JK
authors: Oh
authors: Duk-Kyung
authors: DK
authors: Kim
mesh_terms: D000208:Acute Disease; D000368:Aged; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging*; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016278:Ventricular Function, Right