title: Prognostic implications of computed tomographic right ventricular dilation in patients with acute pulmonary embolism.
abstract: BACKGROUND
  Whether right ventricular (RV) dilation on computerized tomography (RVD-CT) is a useful predictor for clinical outcomes of acute pulmonary embolism (PE) remains debatable. Furthermore, data regarding the best combination of prognostic markers for predicting the adverse outcome of PE are limited.
  
  
  METHODS
  The authors retrospectively reviewed 657 consecutive patients hospitalized at a tertiary referral center with a diagnosis of PE based on multi-detector row CT scan.
  
  
  RESULTS
  Patients were allocated into an adverse outcome group (11% [n = 69]) or a low risk group (89% [n = 588]). Multivariate analysis showed that RVD-CT (RV/left ventricle [LV] diameter ratio ≥ 1), high pulmonary embolism severity index (PESI) score (class IV-V), high N-terminal-pro-B-type natriuretic peptide (NT-proBNP,≥ 1,136 pg/ml), and elevated troponin I (≥ 0.05 ng/ml) significantly predicted an adverse outcome (odds ratio [OR] 6.26, 95% confidence interval [CI] 2.74-14.31, p < 0.001; OR 4.71, 95% CI 2.00-11.07, p < 0.001; OR 2.71, 95% CI 1.15-6.39, p = 0.023; and OR 3.00, 95% CI 1.27-7.07, p = 0.012, respectively). The addition of RVD-CT to PESI, NT-proBNP, troponin I or their combinations enhanced the positive predictive values and positive likelihood ratios of an adverse outcome.
  
  
  CONCLUSIONS
  RVD-CT could be an independent prognostic factor of adverse outcomes in patients with acute PE, and provides additional prognostic value when combined with other prognostic factors.
authors: Department of Internal Medicine, Kyungpook National University School of Medicine,Daegu, Korea.
authors: Keum-Ju
authors: KJ
authors: Choi
authors: Department of Internal Medicine, Kyungpook National University School of Medicine,Daegu, Korea. Electronic address: sicha@knu.ac.kr.
authors: Seung-Ick
authors: SI
authors: Cha
authors: Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea.
authors: Kyung-Min
authors: KM
authors: Shin
authors: Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea.
authors: Jaekwang
authors: J
authors: Lim
authors: Department of Internal Medicine, Kyungpook National University School of Medicine,Daegu, Korea.
authors: Seung-Soo
authors: SS
authors: Yoo
authors: Department of Internal Medicine, Kyungpook National University School of Medicine,Daegu, Korea.
authors: Jaehee
authors: J
authors: Lee
authors: Department of Internal Medicine, Kyungpook National University School of Medicine,Daegu, Korea.
authors: Shin-Yup
authors: SY
authors: Lee
authors: Department of Internal Medicine, Kyungpook National University School of Medicine,Daegu, Korea.
authors: Chang-Ho
authors: CH
authors: Kim
authors: Department of Internal Medicine, Kyungpook National University School of Medicine,Daegu, Korea.
authors: Jae-Yong
authors: JY
authors: Park
authors: Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors: Won-Kee
authors: WK
authors: Lee
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011655:Pulmonary Embolism / Q000150:complications* / Q000175:diagnosis*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: Computed tomography; Prognosis; Pulmonary embolism; Right ventricular dysfunction