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. 2012 Oct;265(1):283-93.
doi: 10.1148/radiol.12110802.

Short-term mortality in acute pulmonary embolism: clot burden and signs of right heart dysfunction at CT pulmonary angiography

Alessandro Furlan  1 , Ayaz Aghayev, Chung-Chou H Chang, Amol Patil, Kyung Nyeo Jeon, Bumwoo Park, David T Fetzer, Melissa Saul, Mark S Roberts, Kyongtae T Bae
Affiliations

Short-term mortality in acute pulmonary embolism: clot burden and signs of right heart dysfunction at CT pulmonary angiography

Alessandro Furlan et al. Radiology. 2012 Oct.

Abstract

Purpose: To assess the correlation between volumetric measurements of clot, semiquantitative clot burden indexes, and signs of right heart dysfunction at computed tomographic (CT) pulmonary angiography in patients with acute pulmonary embolism (PE) and to determine whether clot burden and signs of right heart dysfunction are associated with short-term mortality.

Materials and methods: This retrospective study was institutional review board approved and HIPAA compliant. CT pulmonary angiographic studies (January 2007 through December 2007) with findings positive for PE were retrieved. Two readers evaluated signs of right heart dysfunction at CT pulmonary angiography, measured clot volume using a dedicated software program, and assessed clot burden using semiquantitative scores (Qanadli and Mastora). Spearman rank coefficient was used to investigate correlation between clot burden measures and signs of right heart dysfunction. Uni- and multivariate analyses were used to test association between CT pulmonary angiographic findings and short-term mortality.

Results: A total of 635 CT pulmonary angiographic studies from 635 patients (304 men, 331 women; mean age, 59 years) were included; 39 (6%) patients died within 30 days. Clot volume was strongly correlated with Qanadli score (ρ=0.841, P<.01) and Mastora score (ρ=0.863, P<.01) and moderately correlated (ρ=0.378, P<.01) with the ratio of right ventricle diameter to left ventricle diameter (RV/LV ratio). Among the pulmonary angiographic signs, only increase in RV/LV ratio (cut-off value, 1.0) was independently associated with short-term mortality in multivariate analysis.

Conclusion: Clot volume strongly correlated with semiquantitative CT scores of clot burden, and greater clot volume was associated with higher incidence of right heart dilatation. Increase in RV/LV ratio was associated with short-term mortality; however, measures of clot burden were not.

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Figures

Figure 1:
Figure 1:
Flowchart of patient selection.
Figure 2:
Figure 2:
Box-and-whisker plot shows distribution of clot volume according to the proximal extension of the clot (largest pulmonary artery affected): mediastinal (mean, 9546.3 mm3 ± 699.6; median, 6419.1 mm3), lobar (mean, 2391.8 mm3 ± 234.3; median, 1454.9 mm3), segmental (mean, 613.6 mm3 ± 64.2; median, 314.4 mm3), and subsegmental (mean, 223.8 mm3 ± 23.5; median, 152.1 mm3). Mediastinal = main pulmonary trunk, right and left interlobar arteries.
Figure 3a:
Figure 3a:
Scatter diagrams show strong positive correlation between (a) clot volume and Qanadli score (ρ = 0.841, P <.01) and (b) clot volume and Mastora score (ρ = 0.863, P <.01).
Figure 3b:
Figure 3b:
Scatter diagrams show strong positive correlation between (a) clot volume and Qanadli score (ρ = 0.841, P <.01) and (b) clot volume and Mastora score (ρ = 0.863, P <.01).
Figure 4:
Figure 4:
Scatter diagram shows moderate positive correlation between clot volume and RV/LV ratio (ρ = 0.378, P <.01).
See this image and copyright information in PMC

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