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Non-severe pulmonary embolism: prognostic CT findings

Anne-Line Moroni1, Jean-Luc Bosson, Noélie Hohn

  • 1University J Fourrier, Grenoble, France.

European Journal of Radiology
|April 21, 2010
PubMed

Insights

In patients with non-severe pulmonary embolism (PE), a right/left ventricle diameter ratio greater than 1 predicts mortality, especially with low embolic burden. Other CT parameters were not associated with death.

Area of Science:

  • Cardiology
  • Radiology
  • Pulmonology

Background:

  • Pulmonary embolism (PE) poses a significant mortality risk, even in clinically non-severe cases.
  • Predictive markers for mortality in non-severe PE are crucial for risk stratification.
  • Computed tomography (CT) offers detailed cardiovascular and embolic burden assessment.

Purpose of the Study:

  • To retrospectively evaluate CT-derived cardiovascular parameters and pulmonary artery clot load score.
  • To determine their predictive value for 3-month mortality in patients with non-severe PE.
  • To identify key predictors of mortality in this patient cohort.

Main Methods:

  • Retrospective analysis of 226 CT scans in hemodynamically stable patients with PE.
  • Independent review of CT scans by two observers assessing interventricular septum shape and right/left ventricle (RV/LV) diameter ratio.
  • Cox regression analysis to compare CT parameters with 3-month mortality.
  • Multivariate analysis incorporating lower limb deep vein thrombosis (DVT) and comorbidities.

Main Results:

  • A RV/LV diameter ratio >1 was predictive of death (OR, 3.83; p < 0.01) specifically when embolic burden was < 40%.
  • Interobserver agreement was moderate for interventricular septum shape (κ = 0.41) and substantial for RV/LV ratio (κ = 0.76).
  • CT cardiovascular parameters, as a group, were not associated with death in the multivariate model. Lower limb DVT and comorbidities were significant predictors.

Conclusions:

  • In non-severe PE, an elevated RV/LV diameter ratio is a significant predictor of mortality, particularly in cases with low embolic burden.
  • CT-derived cardiovascular parameters alone are insufficient for predicting mortality in non-severe PE.
  • Concomitant lower limb DVT and comorbid conditions are critical factors influencing mortality in patients with non-severe PE.

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