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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Ann+Thorac+Med
2016 ; 11
(4
): 269-276
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Diagnostic implications of computed tomography pulmonary angiography in patients
with pulmonary embolism
#MMPMID27803753
El-Menyar A
; Nabir S
; Ahmed N
; Asim M
; Jabbour G
; Al-Thani H
Ann Thorac Med
2016[Oct]; 11
(4
): 269-276
PMID27803753
show ga
INTRODUCTION: Pulmonary embolism (PE) is a serious cardiovascular and pulmonary
complication worldwide. We aimed to assess the implications of different computed
tomography pulmonary angiography (CTPA) parameters in patients with acute PE.
METHODS: A retrospective observational study to include patients presented with
clinical suspicious of PE who underwent CTPA was conducted. Patients'
demographics, clinical presentation, risk factors, laboratory investigations,
management, and outcome were analyzed. Computed tomography findings included clot
burden (Qanadli score [QS]) and right ventricular dysfunction (RVD) parameters.
RESULTS: A total of 45 patients with radiologically confirmed diagnosis of PE
were included in the study; of these patients, 8 (17.8%) died during the hospital
course. Patients who died were 13 years older than those who survived, and the
mortality rate was significantly higher in patients with cancer. The two groups
were comparable for cardiovascular parameters. The mean clot burden (QS) was 19.5
± 11.3 points and 53% of patients had QS >18 points. Obesity (52.4% vs. 12.5%; P
= 0.01), hypertension (54.4% vs. 23.8%; P = 0.03), and median D-dimer levels (7.8
vs. 3.4; P = 0.03) were significantly higher in patients with QS >18. Among right
ventricular (RV) dysfunction parameters, only higher RV/left ventricular (LV)
ratio (P = 0.001) and bowing of interventricular septum (P = 0.001) were
associated with higher QS. A significant positive correlation was found between
RV short axis (r = 0.499, P = 0.001), RV/LV ratio (r = 0.592, P = 0.001), and
pulmonary artery (PA) diameter (r = 0.301, P = 0.04) with the PA clot burden.
Receiver operating characteristic curve for clot burden showed a cutoff value of
17.5 points to accurately predict RV dysfunction. CONCLUSIONS: Clot burden >18 is
associated with RV dysfunction in patients with acute PE. Echocardiography and
RVD parameters showed no correlation with in-hospital deaths. CTPA has
clinicoradiological implications for risk stratification in PE patients. As the
sample size is small, our findings warrant further larger prospective studies.