title: Comparison of PESI, echocardiogram, CTPA, and NT-proBNP as risk stratification tools in patients with acute pulmonary embolism.
abstract: OBJECTIVE
  The aim of this study is to prospectively assess the diagnostic accuracy of pulmonary embolism severity index, echocardiogram, computed tomography pulmonary angiogram (CTPA), and N-terminal pro b-type natriuretic peptide (NT-proBNP) for predicting adverse events in acute pulmonary embolism patients.
  
  
  METHODS
  Thirty consecutive acute pulmonary embolism patients were included in this study. Combined adverse events consisted of in-hospital death or use of escalation of care including cardiopulmonary resuscitation, mechanical ventilation, vasopressor therapy, or secondary thrombolysis during hospital stay.
  
  
  RESULTS
  The outcomes were met in 30% of patients. Qanadli index (a measure of clot burden on CTPA) and NT-proBNP were significantly higher in patients with adverse events than those without (p=0.005 and p=0.009, respectively). PESI had moderate positive correlation with right ventricular dysfunction (RVD) (r=0.449, p=0.013) but there was no significant difference in PESI between patients with and without adverse events (p=0.7). Receiver operating characteristic analysis indicated that Qanadli index was the best predictor of adverse events with area under the curve (AUC) of 0.807 (95% CI: 0.651-0.963) with a negative predictive value (NPV) of 100% and positive predictive value (PPV) of 47.4% at cut-off value of 19. Right ventricle to left ventricle ratio on CTPA was found to predict RVD with AUC of 0.94 (95% CI: 0.842-1.000), NPV (77.8%), and PPV (95.2%) at cut-off value at 1.15.
  
  
  CONCLUSIONS
  Qanadli index is more accurate predictor of adverse events than pulmonary embolism severity index, NT-proBNP, and RVD on echocardiogram and CTPA.
authors.affiliation: Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India.
authors.forename: A
authors.initials: A
authors.lastname: Vamsidhar
authors.affiliation: Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India. Electronic address: cardiologysvims@gmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Rajasekhar
authors.affiliation: Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India.
authors.forename: V
authors.initials: V
authors.lastname: Vanajakshamma
authors.affiliation: Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India.
authors.forename: A Y
authors.initials: AY
authors.lastname: Lakshmi
authors.affiliation: Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India.
authors.forename: K
authors.initials: K
authors.lastname: Latheef
authors.affiliation: Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India.
authors.forename: C
authors.initials: C
authors.lastname: Siva Sankara
authors.affiliation: Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India.
authors.forename: G
authors.initials: G
authors.lastname: Obul Reddy
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000072226:Computed Tomography Angiography / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D012372:ROC Curve; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Echocardiogram; NT-proBNP; Pulmonary embolism; Qanadli index; Right ventricle