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Multicenter Study
. 2018 Jul 4;52(1):1702611.
doi: 10.1183/13993003.02611-2017. Print 2018 Jul.

Prognostic value of cardiovascular parameters in computed tomography pulmonary angiography in patients with acute pulmonary embolism

Ludo F M Beenen  1 , Patrick M M Bossuyt  2 , Jaap Stoker  3 , Saskia Middeldorp  4
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Free article
Multicenter Study

Prognostic value of cardiovascular parameters in computed tomography pulmonary angiography in patients with acute pulmonary embolism

Ludo F M Beenen et al. Eur Respir J. .
Free article

Abstract

The value of various computed tomography parameters for prognosis and risk stratification in acute pulmonary embolism is controversial. Our objective was to evaluate the impact of specific cardiovascular computed tomography pulmonary angiography parameters on short- and long-term clinical outcomes.We analysed radiological and clinical data of 1950 patients with acute pulmonary embolism who participated in an international randomised clinical trial on anticoagulants. Parameters included right/left ventricular ratio, septal bowing, cardiothoracic ratio, diameters of pulmonary trunk and aorta, and intrahepatic/azygos vein contrast medium backflow. Associations with mortality, recurrent venous thromboembolism (VTE), hospitalisation, bleeding and adverse events were assessed over the short term (1 week and 1 month) and long term (12 months).Pulmonary trunk enlargement was the only parameter significantly associated with mortality over both the short and long term (OR 4.18 (95% CI 1.04-16.76) at 1 week to OR 2.33 (95% CI 1.36-3.97) after 1 year), as well as with recurrent VTE and hospitalisation.Most of the evaluated radiological parameters do not have strong effects on the short- or long-term outcome in patients with acute pulmonary embolism. Only an enlarged pulmonary trunk diameter carries an increased risk of mortality and recurrent VTE up to 12 months, and can be used for risk stratification.

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Conflict of interest statement

Conflict of interest: L.F.M. Beenen reports fees for the adjudication and scoring of RVD in the Hokusai-VTE study from Daiichi Sankyo, during the conduct of the study. J. Stoker reports fees (paid to institution) for the adjudication and scoring of RVD in the Hokusai-VTE study from Daiichi Sankyo, during the conduct of the study, and research consultancy fees (paid to institution) from Robarts Clinical Trials, outside the submitted work. S. Middeldorp reports grants (paid to institution) for the IIS VTE trial in prophylaxis in pregnant patients and personal fees for speaking and advisory board participation (paid to institution) from GSK, personal fees for speaking and advisory board participation (paid to institution) from Bayer, grants (paid to institution) for the IIS trial into reversal of apixaban and personal fees for speaking and advisory board participation (paid to institution) from BMS-Pfizer, speaker fees (paid to institution) from Boehringer Ingelheim, grants (paid to institution) for the IIS trial in pregnant patients and personal fees for organising thrombosis masterclasses (paid to institution) from Aspen, research grants and personal fees for advisory board participation (paid to institution) from Daiichi Sankyo, and personal fees for steering committee work (paid to institution) from Portola, outside the submitted work.

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