title: Normal ventricular diameter ratio on CT provides adequate assessment for critical right ventricular strain among patients with acute pulmonary embolism.
abstract: There is variability in guideline recommendations for assessment of the right ventricle (RV) with imaging as prognostic information after acute pulmonary embolism (PE). The objective of this study is to identify a clinical scenario for which normal CT-derived right-to-left ventricular (RV/LV) ratio is sufficient to exclude RV strain or PE-related short-term death. This retrospective cohort study included 579 consecutive subjects (08/2003-03/2010) diagnosed with acute PE with normal CT-RV/LV ratio (<0.9), 236 of whom received subsequent echocardiography. To identify a clinical scenario for which CT-RV/LV ratio was considered sufficient to exclude RV strain or PE-related short-term death, a multivariable logistic model was created to detect factors related to subjects for whom subsequent echocardiography detected RV strain or those who did not receive echocardiography and died of PE within 14 days (n = 55). The final model included five variables (c-statistic = 0.758, over-fitting bias = 2.52 %): congestive heart failure (adjusted odds ratio, OR 4.32, 95 % confidence interval, CI 1.88-9.92), RV diameter on CT >45 mm (OR 3.07, 95 % CI 1.56-6.03), age >60 years (OR 2.59, 95 % CI 1.41-4.77), central embolus (OR 1.96, 95 % CI 1.01-3.79), and stage-IV cancer (OR 1.94, 95 % CI 0.99-3.78). If these five factors were all absent (37.1 % of the population), the probability that "CT-RV/LV ratio is sufficient to exclude RV strain/PE-related short-term death" was 0.97 (95 % CI = 0.95-0.99). Normal CT-RV/LV ratio plus readily obtained five clinical predictors were adequate to exclude RV strain or PE-related short-term mortality.
authors.affiliation: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. k-kumamaru@juntendo.ac.jp.|Department of Radiology, Juntendo Univeristy, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. k-kumamaru@juntendo.ac.jp.
authors.forename: Kanako K
authors.initials: KK
authors.lastname: Kumamaru
authors.affiliation: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: George
authors.affiliation: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Nina
authors.initials: N
authors.lastname: Ghosh
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Carlos Gonzalez
authors.initials: CG
authors.lastname: Quesada
authors.affiliation: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.|The Sackler Institute of Graduate Biomedical Sciences, New York University, New York, NY, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Wake
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Marie
authors.initials: M
authors.lastname: Gerhard-Herman
authors.affiliation: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.|The Department of Radiology, The Ottawa Hospital Research Institute, The University of Ottawa Faculty of Medicine, Ottawa, ON, Canada.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Rybicki
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002423:Cause of Death; D016009:Chi-Square Distribution; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D013314:Stress, Mechanical; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
keywords: Clinical guidelines; Computed tomography angiography; Echocardiography; Pulmonary embolism; Right ventricular dysfunction