CT-derived atrial and ventricular septal signs for risk stratification of patients with acute pulmonary embolism: clinical associations of CT-derived signs for prediction of short-term mortality.
A left-bulging atrial septum (AS) is an abnormal sign indicating hemodynamic overloading of the right heart. We tried to evaluate whether computed tomography (CT)-derived AS bulging and ventricular septum (VS) bowing signs would be used to identify patients with acute pulmonary embolism (PE) and significant hemodynamic derangements. In the prospective registry, 208 consecutive patients with a first episode of acute PE diagnosed by chest CT were grouped by clinical hemodynamic assessment: massive or submassive PE (Group 1), and small PE (Group 2). The curvatures of the AS and VS, and the diameters of right ventricle (RV) and left ventricle were measured on chest CT. Group 1 showed higher degrees of echocardiographic RV dysfunction, and abnormal CT-derived VS and AS curvatures versus Group 2. An abnormal VS bowing sign was observed in 32 (32.7%) and 6 (5.5%) patients in Groups 1 and 2, respectively (P < 0.001). An abnormal AS bulging sign was observed in 59 (60.2%) and 32 (29.1%) patients in Groups 1 and 2, respectively (P < 0.001). An algorithm was designed to predict clinically significant hemodynamic abnormality based on these signs. The patients deemed "higher risk" exhibited higher 90-day all-cause mortality than patients in the lower-risk group (P = 0.029). Conventional chest CT-derived hemodynamic findings, including abnormal AS and VS signs, can be used to identify high-risk patients with acute PE and to predict early mortality.
Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea.
Mi-Jeong
MJ
Kim
Hae Ok
HO
Jung
Jung Im
JI
Jung
Ki Joon
KJ
Kim
Doo Soo
DS
Jeon
Ho-Joong
HJ
Youn
D000368:Aged; D000465:Algorithms; D054087:Atrial Septum / Q000000981:diagnostic imaging*; D001794:Blood Pressure; D004452:Echocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D006339:Heart Rate; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000401:mortality*; D012042:Registries; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D013318:Stroke Volume; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis; D054088:Ventricular Septum / Q000000981:diagnostic imaging*
D010100:Oxygen