Multidetector computed tomography to assess clinical outcome in hemodynamically stable patients with acute pulmonary embolism

Background: In patients with acute pulmonary embolism (PE) right ventricle dysfunction (RVD) assessed by multidetector computed tomography (MDCT) has been suggested to be associated with an adverse in-hospital outcome. The aim of this study in hemodynamically stable patients with acute PE was to prospectively assess (i) the prognostic value of MDCT-detected RVD and (ii) the role of MDCT-detected RVD with respect to echocardiography and serum troponin. Methods: Consecutive patients were included in this study if they had (i) symptomatic acute PE diagnosed by MDCT and (ii) echocardiography done and serum troponin measured within 6 h from the diagnostic MDCT. A ratio of right to left ventricle short-axis diameters (R/LV) > 0.9 at the valvular plane in their maximum dimension was the criterion for MDCT-detected RVD. Eight or 16 slice MDCT were used and all were centrally evaluated for RVD. Criteria for RVD at echocardiography were 1) end-diastolic R/LV > 0.7 in parasternal long axis and/or subcostal views, and/or 0.9 in 4 chamber view. Troponin was categorized as high or normal according to the locally used cut-off value. Results: Overall, 310 patients were included in the study (males 142, mean age 66.8 ± 16 years): 213 patients (68%) had RVD at MDCT, 155 patients (50%) had RVD at echocardiography, 104 patients (33.5%) elevated troponin and 93 patients (30%) both. Overall, 27 patients (8.7%) died or had cardiogenic shock during the hospital stay. MDCT had a 100% negative predictive value for death and a 99% negative predictive value for death or cardiogenic shock. RVD at MDCT was an independent predictor for in-hospital death or cardiogenic shock at multivariate logistic regression analysis. In patients with RVD at MDCT echo-RVD (OR 4,3, 95% CI 0.97-19.1) and not serum troponin could be used for further prognostic stratification. Conclusions: Our results support the use of MDCT to predict clinical outcome in patients with acute PE. MDCT can be used to diagnose and risk-profile patients with acute pulmonary embolism.