Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark & Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Emerg Radiol. 2023 Jun;30(3):325-331. doi: 10.1007/s10140-023-02130-z. Epub 2023 Apr 21.
Right ventricular strain (RVS) is used to risk stratify patients with acute pulmonary embolism (PE) and influence treatment decisions. Guidelines suggest that either computed tomography pulmonary angiography (CTPA) or transthoracic echocardiography (TTE) can be used to assess RVS. We sought to determine how often CTPA and TTE yield discordant results and to assess the test characteristics of CTPA compared to TTE.
We analyzed data from a single-center registry of PE cases severe enough to warrant activation of the hospital's Pulmonary Embolism Response Team (PERT). We defined RVS as a right ventricular to left ventricular ratio (RV/LV) ≥ 1 or radiologist's interpretation of RVS on CTPA or as the presence of either RV dilation, hypokinesis, or septal bowing on TTE.
We included 554 patients in our analysis, of whom 333 (60%) had concordant RVS findings on CTPA and TTE. Using TTE as the reference standard, CTPA had a sensitivity of 95% (95% CI 92-97%) and a specificity of 4% (95% CI 2-8%) for identifying RVS.
In a selected population of patients with acute PE for which PERT was activated, CTPA is highly sensitive but not specific for the detection of RVS when compared to TTE.
右心室应变（RVS）用于对急性肺栓塞（PE）患者进行风险分层，并影响治疗决策。指南建议可以使用计算机断层扫描肺动脉造影（CTPA）或经胸超声心动图（TTE）来评估 RVS。我们旨在确定 CTPA 和 TTE 产生不一致结果的频率，并评估 CTPA 与 TTE 的测试特征。
我们分析了一家医院的肺栓塞病例登记处的数据，这些病例严重到需要激活医院的肺栓塞反应小组（PERT）。我们将 RVS 定义为右心室与左心室的比值（RV/LV）≥1，或 CTPA 上放射科医生对 RVS 的解读，或 TTE 上出现 RV 扩张、运动减弱或室间隔凹陷。
我们对 554 名患者进行了分析，其中 333 名（60%）患者在 CTPA 和 TTE 上的 RVS 结果一致。使用 TTE 作为参考标准，CTPA 对 RVS 的敏感性为 95%（95%CI 92-97%），特异性为 4%（95%CI 2-8%）。
在激活 PERT 的急性 PE 患者的选定人群中，与 TTE 相比，CTPA 对 RVS 的检测具有高度敏感性，但特异性较低。
