title: Short-term mortality in acute pulmonary embolism: clot burden and signs of right heart dysfunction at CT pulmonary angiography.
abstract: OBJECTIVE
  To assess the correlation between volumetric measurements of clot, semiquantitative clot burden indexes, and signs of right heart dysfunction at computed tomographic (CT) pulmonary angiography in patients with acute pulmonary embolism (PE) and to determine whether clot burden and signs of right heart dysfunction are associated with short-term mortality.
  
  
  METHODS
  This retrospective study was institutional review board approved and HIPAA compliant. CT pulmonary angiographic studies (January 2007 through December 2007) with findings positive for PE were retrieved. Two readers evaluated signs of right heart dysfunction at CT pulmonary angiography, measured clot volume using a dedicated software program, and assessed clot burden using semiquantitative scores (Qanadli and Mastora). Spearman rank coefficient was used to investigate correlation between clot burden measures and signs of right heart dysfunction. Uni- and multivariate analyses were used to test association between CT pulmonary angiographic findings and short-term mortality.
  
  
  RESULTS
  A total of 635 CT pulmonary angiographic studies from 635 patients (304 men, 331 women; mean age, 59 years) were included; 39 (6%) patients died within 30 days. Clot volume was strongly correlated with Qanadli score (ρ=0.841, P<.01) and Mastora score (ρ=0.863, P<.01) and moderately correlated (ρ=0.378, P<.01) with the ratio of right ventricle diameter to left ventricle diameter (RV/LV ratio). Among the pulmonary angiographic signs, only increase in RV/LV ratio (cut-off value, 1.0) was independently associated with short-term mortality in multivariate analysis.
  
  
  CONCLUSIONS
  Clot volume strongly correlated with semiquantitative CT scores of clot burden, and greater clot volume was associated with higher incidence of right heart dilatation. Increase in RV/LV ratio was associated with short-term mortality; however, measures of clot burden were not.
authors.affiliation: Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213, USA.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Furlan
authors.forename: Ayaz
authors.initials: A
authors.lastname: Aghayev
authors.forename: Chung-Chou H
authors.initials: CC
authors.lastname: Chang
authors.forename: Amol
authors.initials: A
authors.lastname: Patil
authors.forename: Kyung Nyeo
authors.initials: KN
authors.lastname: Jeon
authors.forename: Bumwoo
authors.initials: B
authors.lastname: Park
authors.forename: David T
authors.initials: DT
authors.lastname: Fetzer
authors.forename: Melissa
authors.initials: M
authors.lastname: Saul
authors.forename: Mark S
authors.initials: MS
authors.lastname: Roberts
authors.forename: Kyongtae T
authors.initials: KT
authors.lastname: Bae
mesh_terms: D000792:Angiography / Q000379:methods*; D003287:Contrast Media; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000401:mortality*; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D012984:Software; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014283:Triiodobenzoic Acids; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000401:mortality*
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; C054871:ioversol