Evaluation of right ventricular dysfunction and prediction of clinical outcomes in acute pulmonary embolism by chest computed tomography: Comparisons with echocardiography

Jeong Rang Park, Sung A. Chang, Shin Yi Jang, Hye Jin No, Sung Ji Park, Seung Hyuk Choi, Seung Woo Park, Hojoong Kim, Yeon Hyeon Choe, Kyung Soo Lee, Jae Kuen Oh, Duk Kyung Kim

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

To evaluate the ability to identify right ventricular (RV) dysfunction, and to predict adverse outcomes of chest computed tomography (CT), we compared CT and echocardiography in acute pulmonary embolism patients. We analyzed 56 patients diagnosed by CT with acute pulmonary embolism, who underwent echocardiography within 48 h of CT scan from January 2004 to December 2008. From the CT scan, the ratio of RV diameter to left ventricular diameter (RVd/LVd), the presence of septal bowing and embolus location were determined. RVd/LVd (P<0.001), septal bowing (P<0.001) and proximal embolism (P = 0.016) were associated with echocardiographic RV hypokinesia. The odds ratio for adverse clinical outcomes was 19.2 for the combination of three CT parameters (RVd/LVd>1, septal bowing, and proximal embolism), and 13.4 for RV hypokinesia (each P = 0.001). The positive predictive value (PPV) for adverse clinical outcomes for echocardiographic RV hypokinesia was 55.0%, and the negative predictive value (NPV) was 96.2%. The three-parameter combination predicted adverse clinical outcomes with a PPV of 54.5%, and a NPV of 94.1%. CT parameters including RV dysfunction were significantly associated with poor outcomes. Rapid risk stratification of patients with acute pulmonary embolism based on chest CT appears to be comparable with echocardiography, is clinically reliable, and may be useful in guiding management strategy.

Original languageEnglish (US)
Pages (from-to)979-987
Number of pages9
JournalInternational Journal of Cardiovascular Imaging
Volume28
Issue number4
DOIs
StatePublished - Apr 2012

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Right Ventricular Dysfunction
Pulmonary Embolism
Echocardiography
Thorax
Tomography
Hypokinesia
Embolism

Keywords

  • Adverse clinical outcome
  • Computed tomography
  • Pulmonary embolism
  • Right ventricular dysfunction
  • Right ventricular hypokinesia

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Evaluation of right ventricular dysfunction and prediction of clinical outcomes in acute pulmonary embolism by chest computed tomography : Comparisons with echocardiography. / Park, Jeong Rang; Chang, Sung A.; Jang, Shin Yi; No, Hye Jin; Park, Sung Ji; Choi, Seung Hyuk; Park, Seung Woo; Kim, Hojoong; Choe, Yeon Hyeon; Lee, Kyung Soo; Oh, Jae Kuen; Kim, Duk Kyung.

In: International Journal of Cardiovascular Imaging, Vol. 28, No. 4, 04.2012, p. 979-987.

Research output: Contribution to journalArticle

Park, Jeong Rang ; Chang, Sung A. ; Jang, Shin Yi ; No, Hye Jin ; Park, Sung Ji ; Choi, Seung Hyuk ; Park, Seung Woo ; Kim, Hojoong ; Choe, Yeon Hyeon ; Lee, Kyung Soo ; Oh, Jae Kuen ; Kim, Duk Kyung. / Evaluation of right ventricular dysfunction and prediction of clinical outcomes in acute pulmonary embolism by chest computed tomography : Comparisons with echocardiography. In: International Journal of Cardiovascular Imaging. 2012 ; Vol. 28, No. 4. pp. 979-987.
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AU - No, Hye Jin

AU - Park, Sung Ji

AU - Choi, Seung Hyuk

AU - Park, Seung Woo

AU - Kim, Hojoong

AU - Choe, Yeon Hyeon

AU - Lee, Kyung Soo

AU - Oh, Jae Kuen

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AB - To evaluate the ability to identify right ventricular (RV) dysfunction, and to predict adverse outcomes of chest computed tomography (CT), we compared CT and echocardiography in acute pulmonary embolism patients. We analyzed 56 patients diagnosed by CT with acute pulmonary embolism, who underwent echocardiography within 48 h of CT scan from January 2004 to December 2008. From the CT scan, the ratio of RV diameter to left ventricular diameter (RVd/LVd), the presence of septal bowing and embolus location were determined. RVd/LVd (P<0.001), septal bowing (P<0.001) and proximal embolism (P = 0.016) were associated with echocardiographic RV hypokinesia. The odds ratio for adverse clinical outcomes was 19.2 for the combination of three CT parameters (RVd/LVd>1, septal bowing, and proximal embolism), and 13.4 for RV hypokinesia (each P = 0.001). The positive predictive value (PPV) for adverse clinical outcomes for echocardiographic RV hypokinesia was 55.0%, and the negative predictive value (NPV) was 96.2%. The three-parameter combination predicted adverse clinical outcomes with a PPV of 54.5%, and a NPV of 94.1%. CT parameters including RV dysfunction were significantly associated with poor outcomes. Rapid risk stratification of patients with acute pulmonary embolism based on chest CT appears to be comparable with echocardiography, is clinically reliable, and may be useful in guiding management strategy.

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