CT signs of right ventricular dysfunction: prognostic role in acute pulmonary embolism

The purpose of this study was to compare the prognostic role of various computed tomography (CT) signs of right ventricular (RV) dysfunction, including 3-dimensional ventricular volume measurements, to predict adverse outcomes in patients with acute pulmonary embolism (PE).

Three-dimensional ventricular volume measurements based on chest CT have become feasible for routine clinical application; however, their prognostic role in patients with acute PE has not been assessed.

We evaluated 260 patients with acute PE for the following CT signs of RV dysfunction obtained on routine chest CT: abnormal position of the interventricular septum, inferior vena cava contrast reflux, right ventricle diameter (RVD) to left ventricle diameter (LVD) ratio on axial sections and 4-chamber (4-CH) views, and 3-dimensional right ventricle volume (RVV) to left ventricle volume (LVV) ratio. Comorbidities and fatal and nonfatal adverse outcomes according to the MAPPET-3 (Management Strategies and Prognosis in Pulmonary Embolism Trial-3) criteria within 30 days were recorded.

Fifty-seven patients (21.9%) had adverse outcomes, including 20 patients (7.7%) who died within 30 days. An RVD(axial)/LVD(axial) ratio >1.0 was not predictive for adverse outcomes. On multivariate analysis (adjusting for comorbidities), abnormal position of the interventricular septum (hazard ratio [HR]: 2.07; p = 0.007), inferior vena cava contrast reflux (HR: 2.57; p = 0.001), RVD(4-CH)/LVD(4-CH) ratio >1.0 (HR: 2.51; p = 0.009), and RVV/LVV ratio >1.2 (HR: 4.04; p < 0.001) were predictive of adverse outcomes, whereas RVD(4-CH)/LVD(4-CH) ratio >1.0 (HR: 3.68; p = 0.039) and RVV/LVV ratio >1.2 (HR: 6.49; p = 0.005) were predictive of 30-day death.

Three-dimensional ventricular volume measurement on chest CT is a predictor of early death in patients with acute PE, independent of clinical risk factors and comorbidities. Abnormal position of the interventricular septum, inferior vena cava contrast reflux, and RVD(4-CH)/LVD(4-CH) ratio are predictive of adverse outcomes, whereas RVD(axial)/LVD(axial) ratio >1.0 is not.