Usefulness of computed tomographic pulmonary angiography in the risk stratification of acute pulmonary thromboembolism. Comparison with cardiac biomarkers.

ABSTRACT

BACKGROUND: To evaluate the usefulness of computed tomographic pulmonary angiographic (CTPA) variables in the risk stratification of acute pulmonary thromboembolism (APE) and compare these variables with cardiac biomarkers. METHODS AND RESULTS: Eighty consecutive patients with APE were divided into patients with right ventricular (RV) dysfunction (n=49, 62.1±15.1 years, 31 females) vs. patients without RV dysfunction (n=31, 67.7±13.7 years, 18 females). CTPA variables were analyzed and compared with cardiac biomarkers. The ratio of right to left ventricular dimension (RVD/LVD), CT index of PA clot load, contrast reflux to the inferior vena cava (IVC), and ventricular septal bowing (VSB) were significantly different CTPA variables between the groups. These variables were also significantly associated with cardiac biomarkers. By receiver operation characteristic curve analysis, the area under the curve to predict RV dysfunction was 0.863 for RVD/LVD, 0.841 for PA clot load, 0.744 for contrast reflux to IVC, and 0.635 for VSB. The optimal cut-off value to predict RV dysfunction was 1.12 for RVD/LVD (sensitivity 89.8%, specificity 77.4%) and 19.5 for PA clot load (sensitivity 81.6%, specificity 77.4%). CONCLUSIONS: RVD/LVD, PA clot load, contrast reflux to IVC, and VSB on CTPA were significantly associated with RV dysfunction and cardiac biomarkers in APE. The present study demonstrated that CTPA is useful not only in the diagnosis, but also in the risk stratification of APE.