Chest

Chest

Volume 140, Issue 4, October 2011, Pages 1008-1015
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Original Research
Pulmonary Vascular Disease
Measurement of Right and Left Ventricular Function by ECG-Synchronized CT Scanning in Patients With Acute Pulmonary Embolism: Usefulness for Predicting Short-term Outcome

https://doi.org/10.1378/chest.10-3174Get rights and content

Background

Right ventricular (RV) function is predictive of outcome in patients with acute pulmonary embolism (PE). We assessed the possible incremental value of ventricular function with ECG-synchronized cardiac CT scanning over pulmonary CT scan angiography (CTA) for predicting short-term outcome in patients with suspected acute PE.

Methods

The local ethics committee approved the study, and informed consent was obtained. In addition to standard CTA, 430 consecutive patients (193 men, 237 women; age, 55 ± 17 years) with suspected acute PE underwent ECG-synchronized CT scanning to assess ventricular function. RV/left ventricular (LV) function ratio and pulmonary obstruction index were obtained from non-ECG-synchronized CTA. Ventricular function was used to predict adverse events (< 6 weeks). Receiver operating characteristic analysis was performed to determine differences between ECG-synchronized CT scan and CTA in predicting outcome.

Results

In 113 patients with PE, RV and LV ejection fraction (EF) and RV/LV diameter and volume ratios were associated with adverse outcome (P < .05), whereas vascular obstruction index was not. RVEF had the largest area under the receiver operating characteristic curve (0.75; 95% CI, 0.62-0.88) for predicting adverse outcome but had no significant incremental value over the RV/LV function ratio (0.72; 95% CI, 0.57-0.86; P = .25). All parameters revealed high negative predictive values (94%-98%) but low positive predictive values (13%-18%). For disease-specific outcome, areas under the curve were 0.80 (95% CI, 0.69-0.91) for RVEF vs 0.68 (95% CI, 0.48-0.88) for axial RV/LV ratio; the difference was not significant (P = .07). RVEF and RV/LV ratio proved better predictors for outcome than pulmonary obstruction index (both P < .001).

Conclusions

RVEF was the best predictor for clinical outcome in patients with acute PE. However, incremental value of RVEF over axial RV/LV ratio was not found.

Section snippets

Study Population

This prospective cohort study was approved by the institutional review board of our hospital (Commissie Medische Ethiek, Leiden University Medical Center, Leiden, The Netherlands; Protocol No. P04.070), and all patients provided written informed consent. A total of 430 consecutive hemodynamically stable inpatients and outpatients presenting between June 2005 and December 2008 with suspected acute PE were included. A previous article reports on a part of the same study population.17 All patients

Study Population

In total, 430 patients (193 [45%] men, 27 [55%] women) with suspected acute PE were included. Mean ± SD age for men was 58 ± 15 years and for women, 53 ± 18 years (Table 1). Acute PE was confirmed in 113 patients (26%) (60 [53%] men; 53 [47%] women; age, 57 ± 16 years). Compared with patients without PE, those with acute PE were more often men (53% vs 42%) and more frequently had previous PE or DVT (22% vs 13%) and a history of immobility, trauma, or recent surgery (31% vs 21%). Preexisting

Discussion

The main findings of our study were the following: RVEF obtained with ECG-synchronized cardiac CT scanning was found to be the strongest predictor for clinical outcome in patients with acute PE. However, no significant incremental value was found over RV/LV ratio measurements on pulmonary CTA. RVEF and RV/LV ratio were found to be significantly better predictors than pulmonary artery obstruction index.

Several studies that evaluated the relationship between cardiac parameters and clinical

Acknowledgments

Author contributions: Drs van der Bijl and Klok had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Dr van der Bijl: contributed to the study design, data acquisition and collection, data analysis and interpretation, and manuscript preparation and revision.

Dr Klok: contributed to the study design; data acquisition and collection; data analysis and interpretation; and manuscript preparation, revision, and

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    • Cited by (0)

    Drs van der Bijl and Klok contributed equally to this work.

    Funding/Support: The authors have reported to CHEST that no funding was received for this study.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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    Copyright © 2011 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.