Spiral computed tomographic pulmonary angiography in patients with acute pulmonary emboli and no pre-existing comorbidity: a prospective prognostic panel study.

OBJECTIVE

To investigate the prognostic validity of the right ventricular to left ventricular diameter (RVD/LVD) ratio and Qanadli pulmonary artery obstruction score (PAOS) in hemodynamically stable patients with no pre-existing comorbidities.

METHODS

Sixty-three patients with no previous comorbidity were recruited for this study. The RVD/LVD ratio was calculated based on axial image measurements obtained from contrast-enhanced non-electrocardiography-gated spiral computed tomography (CT) pulmonary angiographic studies. Patients were followed up for 60 days after the initial CT and study variables including demographic data, the RVD/LVD ratio and PAOS were compared between deceased cases and survivors via univariate and multivariate statistical models.

RESULTS

The 60-day mortality rate was 22.2%. The deceased and surviving groups were comparable for PAOS, whereas both the median age and RVD/LVD ratio were significantly higher in the first group. In multivariate analysis, however, age was the only significant, independent predictor of 60-day mortality (p = 0.02, Exp(B) = 1.06). At a cut-off age of 63 years the 60-day mortality was predicted with a sensitivity and specificity of 64.3% and 69.4%, respectively.

CONCLUSIONS

The RVD/LVD ratio and PAOS are not independent predictors of mortality in hemodynamically stable patients with acute PE and no pre-existing comorbidities.

KEY POINTS

• Patients with pulmonary embolism and no pre-existing comorbidity were studied. • The PAOS alone cannot predict mortality in these patients. • Right ventricle strain is not an independent prognostic factor for mortality in pulmonary embolism. • Age is the only independent predictor of death in pulmonary embolism.