title: Computed tomography and echocardiography in patients with acute pulmonary embolism: part 2: prognostic value.
abstract: OBJECTIVE
  The aim of the study was to compare the prognostic value of right ventricular (RV) dysfunction detected on computed tomography pulmonary angiography (CTPA) and transthoracic echocardiography (TTE) in patients with acute pulmonary embolism (PE).
  
  
  METHODS
  From all consecutive CTPAs performed between August 2003 and May 2010 that were positive for acute PE (n=1744), those with TTE performed within 48 hours of CTPA (n=785) were selected as the study cohort. Multivariate logistic regression analysis was performed to assess the association of CTPA RV/left ventricular (LV) diameter ratio and TTE RV strain with PE-related 30-day mortality, including other associated factors as covariates. The predictive ability (area under the curve) was compared between the model including the CT RV/LV diameter ratio and that including TTE RV strain. Test characteristics of the 2 modalities were calculated.
  
  
  RESULTS
  Both CT RV/LV diameter ratio and TTE RV strain were independently associated with PE-related 30-day mortality (adjusted odds ratio=1.14, P=0.023 for 0.1 increment of the CT RV/LV diameter ratio; and odds ratio=2.13, P=0.041 for TTE RV strain). History of congestive heart failure and malignancy were independent predictors of PE-related mortality, while there was significantly lower mortality associated with anticoagulation use. The model including TTE RV strain and that including CT RV/LV had similar predictive ability (area under the curve=0.80 vs. 0.81, P=0.50). The sensitivity, specificity, and positive and negative predictive values of TTE RV strain and CT RV/LV diameter ratio at a cutoff of ≥1.0 were similar for PE-related 30-day mortality.
  
  
  CONCLUSIONS
  Both RV strain on TTE and an increased CT RV/LV diameter ratio are predictors of PE-related 30-day mortality with similar prognostic significance.
authors.affiliation: *Applied Imaging Science Laboratory, Department of Radiology †Department of Medicine, Cardiovascular Division ‡Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston §Department of Radiology, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: George
authors.forename: Kanako K
authors.initials: KK
authors.lastname: Kumamaru
authors.forename: Nina
authors.initials: N
authors.lastname: Ghosh
authors.forename: Carlos
authors.initials: C
authors.lastname: Gonzalez Quesada
authors.forename: Nicole
authors.initials: N
authors.lastname: Wake
authors.forename: Arash
authors.initials: A
authors.lastname: Bedayat
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Dunne
authors.forename: Sachin S
authors.initials: SS
authors.lastname: Saboo
authors.forename: Ashish
authors.initials: A
authors.lastname: Khandelwal
authors.forename: Andetta R
authors.initials: AR
authors.lastname: Hunsaker
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Rybicki
authors.forename: Marie
authors.initials: M
authors.lastname: Gerhard-Herman
mesh_terms: D000208:Acute Disease; D000368:Aged; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography