title: Right ventricular function and thrombus load in patients with pulmonary embolism and diagnostic delay.
abstract: BACKGROUND
  It has been reported that the time between symptom onset and objective diagnosis of pulmonary embolism (PE) does not affect patients' prognosis with regard to re-thrombosis and mortality risk. However, this observation is contra-intuitive and poorly understood. We further elaborated on this paradox by evaluating thrombus load and right ventricular function in patients with and without diagnostic delay.
  
  
  METHODS
  We performed a post hoc analysis of a previously published observational prospective outcome study in 113 consecutive PE patients. Qanadli-score and RV/LV ratio were scored in all patients, as was the duration from symptom onset to clinical presentation and diagnosis. Diagnostic delay was defined as a period of more than 7 days between symptom onset and clinical presentation. Further endpoints were mortality and hospital readmission in a 6-week follow-up period.
  
  
  RESULTS
  Twenty patients with and 93 patients without delay were studied, who had comparable baseline characteristics and co-morbidities. In linear analyses, Qanadli-score (R² of 0.021; P = 0.130) and RV/LV ratio (R² < 0.001; P = 0.991) were not associated with diagnostic delay. Likewise, longer delay was not predictive of 6-week mortality (odds ratio, 0.65; 95% CI, 0.08-5.57) or hospital readmission (odds ratio, 0.75; 95% CI, 0.15-3.65).
  
  
  CONCLUSIONS
  In our patient cohort, diagnostic delay was not associated with higher thrombus load or right ventricular dysfunction. This provides a possible explanation for the lack of prognostic relevance of diagnostic delay.
authors.affiliation: Department of Thrombosis and Haemostasis, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: S M
authors.initials: SM
authors.lastname: Pasha
authors.forename: F A
authors.initials: FA
authors.lastname: Klok
authors.forename: N
authors.initials: N
authors.lastname: van der Bijl
authors.forename: A
authors.initials: A
authors.lastname: de Roos
authors.forename: L J M
authors.initials: LJ
authors.lastname: Kroft
authors.forename: M V
authors.initials: MV
authors.lastname: Huisman
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000503:physiopathology*; D013927:Thrombosis / Q000503:physiopathology*; D016278:Ventricular Function, Right
keywords: delayed diagnosis; multidetector computed tomography; outcomes assessment; pulmonary embolism; ventricular function, right