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Thorax doi:10.1136/thoraxjnl-2012-202900
  • Pulmonary vasculature
  • Original article

Prognostic significance of multidetector CT in normotensive patients with pulmonary embolism: results of the protect study

  1. 1Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain
  2. 2Respiratory Department, Txagorritxu Hospital, Vitoria, Spain
  3. 3Medicine Department, Germans Trias I Pujol Hospital, Badalona, Spain
  4. 4F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA
  5. 5Respiratory Department, Galdakao Hospital, Galdakao, Spain
  6. 6Respiratory Department, San Pedro Hospital, Logroño, Spain
  7. 7Respiratory Department, Virgen del Rocío Hospital, Sevilla, Spain
  8. 8Respiratory Department, La Fe Hospital, Valencia, Spain
  9. 9Medicine Department, Hospital Xeral Calde, Lugo, Spain
  10. 10Medicine Department, Hospital Sierrallana, Cantabria, Spain
  11. 11Medicine Department, Hospital Parc Tauli, Sabadell, Spain
  12. 12Respiratory Department, Hospital San Juan de Dios, Sevilla, Spain
  13. 13Respiratory Department, Hospital Central Asturias, Oviedo, Spain
  14. 14Respiratory Department, Hospital Lozano Blesa, Zaragoza, Spain
  15. 15Respiratory Department, Hospital Cruces, Bilbao, Spain
  16. 16Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland
  17. 17Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
  1. Correspondence to Dr David Jiménez Castro, Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Madrid 28034, Spain; djc_69_98{at}yahoo.com
  • Received 21 October 2012
  • Revised 25 February 2013
  • Accepted 27 February 2013
  • Published Online First 22 March 2013

Abstract

Background In patients with acute pulmonary embolism (PE), rapid and accurate risk assessment is paramount in selecting the appropriate treatment strategy. The prognostic value of right ventricular dysfunction (RVD) assessed by multidetector CT (MDCT) in normotensive patients with PE has lacked adequate validation.

Methods The study defined MDCT-assessed RVD as a ratio of the RV to the left ventricle short axis diameter greater than 0.9. Outcomes assessed through 30 days after the diagnosis of PE included all-cause mortality and ‘complicated course’, which consisted of death from any cause, haemodynamic collapse or recurrent PE.

Results MDCT detected RVD in 533 (63%) of the 848 enrolled patients. Those with RVD on MDCT more frequently had echocardiographic RVD (31%) than those without RVD on MDCT (9.2%) (p<0.001). Patients with RVD on MDCT had significantly higher brain natriuretic peptide (269±447 vs 180±457 pg/ml, p<0.001) and troponin (0.10±0.43 vs 0.03±0.24 ng/ml, p=0.001) levels in comparison with those without RVD on MDCT. During follow-up, death occurred in 25 patients with and in 13 patients without RVD on MDCT (4.7% vs 4.3%; p=0.93). Those with and those without RVD on MDCT had a similar frequency of complicated course (3.9% vs 2.3%; p=0.30).

Conclusions The PROgnosTic valuE of CT study showed a relationship between RVD assessed by MDCT and other markers of cardiac dysfunction around the time of PE diagnosis, but did not demonstrate an association between MDCT–RVD and prognosis.

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