title: Central emboli rather than saddle emboli predict adverse outcomes in patients with acute pulmonary embolism.
abstract: BACKGROUND
  In patients with acute pulmonary embolism (PE), the prognostic implications of saddle or central emboli, as observed on computed tomography (CT), remain to be established. The aim of the present study was to assess whether the presence of saddle and central emboli could be used to predict clinical outcomes in patients with PE.
  
  
  METHODS
  The authors retrospectively reviewed 743 consecutive patients hospitalized at a tertiary referral center with a diagnosis of PE based on multi-detector row CT scan.
  
  
  RESULTS
  All the clinical variables did not differ between saddle emboli (5.8% [n = 43]) and right or left pulmonary artery emboli (29.7% [n = 221]), and the frequency of an adverse outcome was not significantly different between the two groups. Saddle emboli and right or left pulmonary artery emboli were grouped into central emboli (35.5% [n = 264]). Patients were allocated to an adverse outcome group (10.5% [n = 78]) or a control group (89.5% [n = 665]). Multivariate analysis demonstrated that PE severity index (PESI) score (class IV-V), N-terminal-pro-B-type natriuretic peptide level (≥ 1,406 pg/mL), right ventricular dilation on CT (right ventricle/left ventricle diameter ratio ≥ 1), and central emboli significantly predicted an adverse outcome. The addition of central emboli to other established prognostic factors such as PESI enhanced the positive predictive values and positive likelihood ratios of an adverse outcome for acute PE.
  
  
  CONCLUSIONS
  Rather than saddle emboli, central emboli could be an independent prognostic factor of adverse outcomes in patients with acute PE and provide additional prognostic value when combined with other prognostic factors.
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Keum-Ju
authors.initials: KJ
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea. Electronic address: sicha@knu.ac.kr.
authors.forename: Seung-Ick
authors.initials: SI
authors.lastname: Cha
authors.affiliation: Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Kyung-Min
authors.initials: KM
authors.lastname: Shin
authors.affiliation: Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Jae-Kwang
authors.initials: JK
authors.lastname: Lim
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Seung-Soo
authors.initials: SS
authors.lastname: Yoo
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Jaehee
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Shin-Yup
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Chang-Ho
authors.initials: CH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Jae-Yong
authors.initials: JY
authors.lastname: Park
authors.affiliation: Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Won-Kee
authors.initials: WK
authors.lastname: Lee
mesh_terms: D000208:Acute Disease; D000368:Aged; D005260:Female; D006801:Humans; D008168:Lung / Q000098:blood supply / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D011651:Pulmonary Artery / Q000473:pathology*; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D012189:Retrospective Studies
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Computed tomography; Prognosis; Pulmonary arteries; Pulmonary embolism