title: Multidetector CT scan for acute pulmonary embolism: embolic burden and clinical outcome.
abstract: BACKGROUND
  In patients with acute pulmonary embolism (PE), the correlation between the embolic burden assessed by multidetector CT (MDCT) scan and clinical outcomes remains unclear. Patients with symptomatic acute PE diagnosed based on MDCT angiography were included in a multicenter study aimed at assessing the prognostic role of the embolic burden evaluated with MDCT scan.
  
  
  METHODS
  Embolic burden was assessed as (1) localization of the emboli as central (saddle or at least one main pulmonary artery), lobar, or distal (segmental or subsegmental arteries) and (2) the obstruction index by the scoring system of Qanadli. The primary outcome was 30-day all-cause death or clinical deterioration. Predictors of all-cause death or clinical deterioration were identified by Cox regression statistics.
  
  
  RESULTS
  Overall, 579 patients were included in the study; 60 (10.4%) died or had clinical deterioration at 30 days. Central localization of emboli was not associated with all-cause death or clinical deterioration (hazard ratio [HR], 2.42; 95% CI, 0.77-7.59; P 5 .13). However, in 516 hemodynamically stable patients, central localization of emboli (HR, 8.3; 95% CI, 1.0-67; P 5 .047) was an independent predictor of all-cause death or clinical deterioration, whereas distal emboli were inversely associated with these outcome events (HR, 0.12; 95% CI, 0.015-0.97; P 5 .047). No correlation was found between obstruction index (evaluated in 448 patients) and all-cause death or clinical deterioration in the overall study population and in the hemodynamically stable patients.
  
  
  CONCLUSIONS
  In hemodynamically stable patients with acute PE, central emboli are associated with an increased risk for all-cause death or clinical deterioration. This risk is low in patients with segmental or subsegmental PE.
authors.affiliation: Internal and Cardiovascular Medicine-Stroke Unit, S Maria della Misericordia Hospital, Perugia, Italy. Electronic address: mcristinaved@yahoo.it.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Vedovati
authors.affiliation: Internal and Cardiovascular Medicine-Stroke Unit, S Maria della Misericordia Hospital, Perugia, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Becattini
authors.affiliation: Internal and Cardiovascular Medicine-Stroke Unit, S Maria della Misericordia Hospital, Perugia, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
authors.affiliation: Department of Vascular Medicine, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Pieter W
authors.initials: PW
authors.lastname: Kamphuisen
authors.affiliation: Department of Internal Medicine, Cecina Hospital, Cecina, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Masotti
authors.affiliation: Department of Internal Medicine and Cardiology, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Pruszczyk
authors.affiliation: Department of Cardiology, San Carlo Borromeo Hospital, Milan, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Casazza
authors.affiliation: Department of Emergency Medicine, Ancona Hospital, Ancona, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Salvi
authors.affiliation: Department of Emergency Medicine, Careggi Hospital, Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Grifoni
authors.affiliation: Department of Internal Medicine, Valduce Hospital, Como, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Carugati
authors.affiliation: Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Konstantinides
authors.affiliation: Department of Vascular Medicine, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Marthe
authors.initials: M
authors.lastname: Schreuder
authors.affiliation: Department of Radiology, Warsaw Medical University, Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Golebiowski
authors.affiliation: University of Perugia, and Department of Radiology, S Maria della Misericordia Hospital, Perugia, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Duranti
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005060:Europe; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D011379:Prognosis; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index