Markers of right ventricular dysfunction predict 30-day adverse prognosis of pulmonary embolism on pulmonary computed tomographic angiography

Abstract

To investigate the value of parameters of the pulmonary artery and right ventricular function in predicting the 30-day poor prognosis of patients with acute pulmonary embolism (APE). The heart rate, respiratory rate, systolic blood pressure, Wells score for APE, history of recent operation or immobilization, history of cancer, respiratory failure, smoking were significantly (P < .05) different among the control, good prognosis, and poor prognosis groups. The maximal short diameter of the right and left ventricle (RVD/LVD) ratio (P < .001) and left pulmonary artery (LPA) (P = .01) were significantly different between the good and poor prognosis groups. Systolic blood pressure (odds ratio [OR]: 0.98, P = .045) and the RVD/LVD ratio (OR: 12.57, P = .02) were significant independent risk factors for poor prognosis. The risk for poor prognosis significantly increased when the RVD/LVD ratio was >1.11 (cutoff value) with the area under the curve (AUC) of 0.71 (95% confidence interval [CI]: 0.61-0.80, P < .001). LPA (OR: 9.12, P = .01) and RVD/LVD (OR: 4.62, P = .012) were the significant independent risk factors for poor prognosis in the central pulmonary embolism. The LPA of 2.1 cm had the highest predictive value for poor prognosis in the central APE (AUC: 0.68; sensitivity 84.6%; specificity 53.1%). The RVD/LVD ratio and systolic blood pressure are significant risk factors for short-term prognosis in patients with APE. When the LPA is >2.1 cm in the central APE or the RVD/LVD is >1.11, the risk of poor prognosis increases, which can be used as important indicators for predicting the prognosis of patients with APE. Two hundred forty-three APE patients and 61 patients without APE who underwent computed tomographic pulmonary angiography (CTPA) were retrospectively enrolled as the experimental and the control group, respectively. APE patients who were followed up at the 30-day time point were divided into the good prognosis (n = 195) and poor prognosis group (n = 32). The main pulmonary artery (MPA) to the aorta (AO) ratio, maximal diameter of the LPA and right pulmonary artery (RPA), ratio of the RVD/LVD and the height and volume of the pulmonary artery (PAh and PAV, respectively) were analyzed after indexing to the body surface area.

Figure 1.

Data measurement was performed on the axial plane images of computed tomography pulmonary angiography (CTPA). (A–C) The maximal diameter of the main pulmonary artery (MPA) and the aorta (AO) (A), right and left pulmonary arteries (RPA and LPA) (B and C) were measured. The diameter of MPA is 25.0 mm, and the AO diameter is 28.3 mm (A). The maximal diameter of RPA is 19.6 mm (B), and the maximal diameter of LPA is 19.0 mm (C). (D) The maximal right ventricular diameter (RVD) and left ventricular diameter (LVD) were measured. The width of right ventricle is 46.7 mm, and the width of left ventricle is 32.9 mm. The ratio of RVD/LVD is 1.42. RVD/LVD = maximal short diameter of the right and left ventricles.

Figure 2.

Markers of right ventricular dysfunction was performed on the images of computed tomography pulmonary angiography (CTPA). (A) The distance from the pulmonary valve to the main pulmonary branch is 52.1 mm. (B) Pulmonary artery volume was measured on 3D imaging including the sum of the volumes of the main, right and left pulmonary arteries. (C) The ventricular septum was bowing (arrow) towards the left ventricle. (D) Reflux of contrast medium occurred into the inferior vena cava and the distal hepatic vein.

Figure 3.

Flowchart of patient enrollment.

Figure 4.

The receiver operating characteristics (ROC) cure analysis of the ratio of the maximal short diameter of the right and left ventricles (RVD/LVD) for predicting poor prognosis of patients with acute pulmonary embolism.