Year : 2020 | Volume
: 15 | Issue : 2 | Page : 64--69
Correlating computed tomography pulmonary angiography signs of right ventricular strain in pulmonary embolisms to clinical outcomes
Jay Karri1, Tiffany Truong1, Joseph Hasapes2, Daniel Ocazionez Trujillo2, Steven Chua2, Kaustubh Shiralkar2, Gabriel Aisenberg1
1 Department of Internal Medicine, McGovern Medical School, UTHSC, Houston, Texas, USA
2 Department of Diagnostic and Interventional Imaging, McGovern Medical School, UTHSC, Houston, Texas, USA
INTRODUCTION: Right ventricular strain (RVS) in pulmonary embolism (PE) can be used to stratify risk and direct intervention. The clinical significance of computed tomography pulmonary angiogram (CTPA)-derived radiologic signs of RVS, however, remains incompletely characterized. We retrospectively analyzed a cohort of persons with acute PE to determine which, if any, findings of RVS on CTPA correlate with clinical outcomes.
METHODS: All patients with PE diagnosed on CTPA from March 2013 through February 2015 at Lyndon B. Johnson Hospital were identified. Their records were retrospectively reviewed to identify length of stay, intensive care unit (ICU) placement, hemodynamic failure, use of thrombolytics, vasopressor requirement, mechanical ventilation, and attributable mortality. Three radiologists, blinded to clinical outcomes, separately reviewed the cohort's CTPAs to identify signs of RVS – pulmonary trunk size, internal size of the right and left ventricles, paradoxical interventricular septal bowing, inferior vena cava (IVC) contrast reflux, and hepatic vein contrast reflux.
RESULTS: In our cohort of 102 persons, 12 demonstrated hemodynamic failure, 13 required ICU placement, 3 received thrombolysis, and 5 had death attributable to PE. The greatest interobserver agreement among radiologists existed for the presence of increased pulmonary trunk size (0.76 kappa by %agreement) and hepatic vein contrast reflux (0.92 kappa by %agreement). A multiple regression analysis found that when 100% radiologist agreement existed, presence of paradoxical intravenous septal bowing predicted thrombolytic usage (P = 0.02), and the presence of IVC reflux predicted attributable mortality (P = 0.03).
CONCLUSION: Only IVC contrast reflux was associated with increased mortality, and no other sign of RVS on CTPA correlated with clinical outcomes. This suggests that most signs of RVS on CTPA do not reliably predict PE severity. Therefore, RVS seen by CTPA should be used cautiously in weighing the decision to initiate thrombolytics.
Dr. Gabriel Aisenberg
6432 Fannin St., MSB 1.122, Houston 77030, Texas
|How to cite this article:|
Karri J, Truong T, Hasapes J, Trujillo DO, Chua S, Shiralkar K, Aisenberg G. Correlating computed tomography pulmonary angiography signs of right ventricular strain in pulmonary embolisms to clinical outcomes.Ann Thorac Med 2020;15:64-69
|How to cite this URL:|
Karri J, Truong T, Hasapes J, Trujillo DO, Chua S, Shiralkar K, Aisenberg G. Correlating computed tomography pulmonary angiography signs of right ventricular strain in pulmonary embolisms to clinical outcomes. Ann Thorac Med [serial online] 2020 [cited 2020 Jul 6 ];15:64-69
Available from: http://www.thoracicmedicine.org/article.asp?issn=1817-1737;year=2020;volume=15;issue=2;spage=64;epage=69;aulast=Karri;type=0