Respiratory Medicine
Volume 104, Issue 7 , Pages 1057-1062 , July 2010

Right ventricular dilation on CT pulmonary angiogram independently predicts mortality in pulmonary embolism

  • Aran Singanayagam

      Affiliations

    • Department of Respiratory Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
    • Corresponding Author InformationCorresponding author. Tel.: +44 7810423273; fax: +44 1312421870.
    • ,
  • James D. Chalmers

      Affiliations

    • Department of Respiratory Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
    • ,
  • Caroline Scally

      Affiliations

    • Department of Respiratory Medicine, Ninewells Hospital, Dundee DD19SY, UK
    • ,
  • Ahsan R. Akram

      Affiliations

    • Department of Respiratory Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
    • ,
  • Mudher Z. Al-Khairalla

      Affiliations

    • Department of Respiratory Medicine, Ninewells Hospital, Dundee DD19SY, UK
    • ,
  • Leah Leitch

      Affiliations

    • Department of Respiratory Medicine, Ninewells Hospital, Dundee DD19SY, UK
    • ,
  • Louise E. Hill

      Affiliations

    • Department of Radiology, St. John's Hospital, Livingston EH54 6PP, UK
    • ,
  • Adam T. Hill

      Affiliations

    • Department of Respiratory Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK

Received 19 June 2009 ,Accepted 4 February 2010.

References 

  1. Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the task force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology. Eur Heart J. 2008;29:2276–2315
  2. Wan S, Quinlan DJ, Agnelli G, Eikelboom JW. Thrombolysis compared with heparin for initial treatment of pulmonary embolism: a meta-analysis of the randomised controlled trials. Circulation. 2004;110:744–749
  3. Hamel E, Pacouret G, Vincentelli D, et al. Thrombolysis or heparin therapy in massive pulmonary embolism with right ventricular dilation: results from a 128-patient monocentre registry. Chest. 2001;120:120–125
  4. Viellard-Baron A, Page B, Augarde R, et al. Acute cor pulmonale in massive pulmonary embolism: incidence, Echocardiographic pattern, clinical implications and recovery rate. Intensive Care Med. 2001;27:1481–1486
  5. Konstantinides S, Geibel A, Heusel G, Heinrich F, Kasper W. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med. 2002;347:1143–1150
  6. Ramakrishnan N. Thrombolysis is not warranted in submassive pulmonary embolism: a systemic review and meta-analysis. Crit Care Resusc. 2007;9:357–363
  7. Goldhaber SZ. Modern treatment of pulmonary embolism. Eur Resp J. 2002;35(Supp.):22s–27s
  8. Becattini C, Agnelli G. Acute pulmonary embolism: risk stratification in the emergency department. Intern Emerg Med. 2007;2:119–129
  9. Grifoni S, Olivotto I, Cecchini P, et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure and Echocardiographic right ventricular dysfunction. Circulation. 2000;101:2817–2822
  10. Sanchez O, Trinquart L, Colombet I, et al. Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: a systematic review. Eur Heart J. 2008;29:1569–1577
  11. Ribeiro A, Lindmarker A, Juhlin-Dannfelt A, Johnsson H, Jorfeldt L. Echocardiography Doppler in pulmonary embolism: right ventricular dysfunction as a predictor of mortality rate. Am Heart J. 1997;134:479–487
  12. Goldhaber SZ. Echocardiography in the management of pulmonary embolism. Ann Intern Med. 2002;136:691–700
  13. Goldhaber SZ. Cardiac biomarkers in pulmonary embolism. Chest. 2003;123:1782–1784
  14. Vuilleumier N, Righini M, Perrier A, et al. Correlation between cardiac biomarkers and right ventricular enlargement on chest CT in non massive pulmonary embolism. Thromb Res. 2008;121:617–624
  15. Logeart D, Lecuyer L, Thabut G, et al. Biomarker-based strategy for screening right ventricular dysfunction in patients with non-massive pulmonary embolism. Intensive Care Med. 2007;33:286–292
  16. Araoz PA, Gotway MB, Trowbridge RL, et al. Helical CT pulmonary angiography predictors of in-hospital mortality in patients with acute pulmonary embolism. J Thorac Imaging. 2003;18:207–216
  17. Ghaye B, Ghuysen A, Willems V, et al. Severe pulmonary embolism: pulmonary artery clot loads and cardiovascular parameters as predictors of mortality. Radiology. 2006;239:884–891
  18. Schoepf UJ, Kucher N, Kipfmueller F, Quiroz R, Costello P, Goldhaber SZ. Right ventricular enlargement on chest computed tomography: a predictor of early death in acute pulmonary embolism. Circulation. 2004;110:3276–3280
  19. Collomb D, Paramelle PJ, Calaque O, et al. Severity assessment of acute pulmonary embolism: evaluation using helical CT. Eur Radiol. 2003;13:1508–1514
  20. Contractor S, Maldjian PD, Sharma VK, Gor DM. Role of helical CT in detecting right ventricular dysfunction secondary to acute pulmonary embolism. J Comput Assist Tomogr. 2002;26:587–591
  21. Lim KE, Chan CY, Chu PH, Hsu YY, Hsu WC. Right ventricular dysfunction secondary to acute massive pulmonary embolism detected by helical computed tomography pulmonary angiography. Clin Imaging. 2005;29:16–21
  22. Mansecal N, Joseph T, Vielliard-Baron A, et al. Diagnosis of right ventricular dysfunction in acute pulmonary embolism using helical computed tomography. Am J Cardiol. 2005;95:1260–1263
  23. Ghuysen A, Ghaye B, Willems V, Lambermont B, Dondelinger RF, D'Orio V. Computed tomographic pulmonary angiography and prognostic significance in patients with acute pulmonary embolism. Thorax. 2005;60:956–961
  24. Van de Meer RW, Pattynama PMT, Van Strijen MJL, et al. Right Ventricular dysfunction and pulmonary obstruction index at helical CT: prediction of clinical outcome during 3 month follow-up in patients with acute pulmonary embolism. Radiology. 2005;235:798–803
  25. Aujesky D, Obrosky DS, Stone RA, et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Resp Crit Care Med. 2005;172:1041–1046
  26. Aujesky D, Obrosky DS, Stone RA, et al. A prediction rule to identify low-risk patients with pulmonary embolism. Arch Intern Med. 2006;166:169–175
  27. Jimenez D, Yusen RD, Otero R, et al. Prognostic models for selecting patients with acute pulmonary embolism for initial outpatient therapy. Chest. 2007;132:24–30
  28. Wicki J, Perrier A, Perneger TV, Bounameaux H, Junod AF. Predicting adverse outcome in patients with acute pulmonary embolism: a risk score. Thromb Haemostat. 2000;84:548–552
  29. Ghaye B, Ghuysen A, Bruyere PJ, D'Orio V, Dondelinger RF. Can CT pulmonary angiography allow assessment of severity and prognosis in patients presenting with pulmonary embolism? What the radiologist needs to know. Radiographics. 2006;26:23–40
  30. Mastora I, Remy-Jardin M, Masson P, et al. Severity of acute pulmonary embolism: evaluation of a new spiral CT angiographic score in correlation with echographic data. Eur Radiol. 2003;13:29–35
  31. Aviram G, Rogowski O, Gotler Y, et al. Real time risk stratification of patients with acute pulmonary embolism by grading the reflux of contrast into the inferior vena cava on computerized tomographic pulmonary angiography. J Thromb Haemostat. 2008 Jul 12;[Epub ahead of print]
  32. Kreit JW. The Impact of Right Ventricular Dysfunction on the Prognosis and Therapy of Normotensive patients with pulmonary embolism. Chest. 2004;125:1539–1545
  33. Miller G, Sutton GC, Kerr IH, Gibson RV, Honey M. Comparison of streptokinase and heparin in treatment of isolated acute massive pulmonary embolism. BMJ. 1971;2:681–684

PII: S0954-6111(10)00055-7

doi: 10.1016/j.rmed.2010.02.004

Respiratory Medicine
Volume 104, Issue 7 , Pages 1057-1062 , July 2010

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