The value of CTPA for diagnosing acute pulmonary thromboembolism and the ensuing right ventricular dysfunction

The value of computed tomography pulmonary angiography (CTPA) for the diagnosis of right ventricular dysfunction (RVD) subsequent to acute pulmonary embolism (PE). The ultrasonic cardiography (UCG) was used to assess RVD, one of the diagnostic criteria of PE caused hemodynamic collapse. Seventy six patients with confirmed PE were divided into massive (52 cases) and non-massive PE group (24 cases). The diagnostic criteria assessed for the imminent RVD were: (1) the ratio of axial diameters of the right and left ventricular chambers (RVd/LVd) exceeding 1, or (2) the right ventricular end-diastolic diameter measuring >30 mm. The CTPA diagnosed RVD was positive in 36 and negative in 40 cases. The RVD assessed by UCG was positive in 31 and negative in 45 cases. In comparison to UCG, the CTPA results UCG exhibited 96.77 % sensitivity 96.77 % and 86.67 specificity. The evaluated values both of these techniques were found in good agreement by the kappa value (κ) of 0.81, P < 0.001. In 52 cases of massive PE, CTPA determined RVD was positive in 34, and negative in 18 cases. In comparison, UCG diagnosed RVD was positive in 31 and negative in 21 cases. The sensitivity and specificity of CTPA results compared to those of UCG were 91.18 and 85.71 %, respectively. The estimates obtained were in good agreement as indicated by 0.88 κ value and P < 0.001. Twenty four cases of non-massive PE were RVD negative when assessed by CTPA, UCG however showed two cases positive in this group. Compared to UCG, the specificity of CTPA in evaluating RVD was 100 %. In the massive PE group, the average estimate of RVd/LVd ratio was significantly higher than 1 as analyzed by the non-parametric Mann-Whitney test (P < 0.001). The CTPA and UCG results showed a good correlation in massive PE cases. However, in non-massive PE group, results from two techniques were not correlated. The CTPA can accurately and reliably diagnose the PE and ensuing by estimating changes in the anatomical parameters of right ventricle. Hence, it can allow prompt diagnosis and an appropriate treatment leading to an improved prognosis.