Predictive Value of Computed Tomography in Acute Pulmonary Embolism: Systematic Review and Meta-analysis

Area of Science:

• Radiology
• Cardiology
• Pulmonary Medicine

Background:

• Computed tomography (CT) offers various parameters to predict outcomes in acute pulmonary embolism (PE).
• Evidence on the predictive value of CT severity parameters for short-term clinical outcomes in PE requires summarization.

Purpose of the Study:

• To systematically review and summarize the evidence on the predictive value of CT parameters for short-term clinical outcomes in acute pulmonary embolism.
• To assess the association between specific CT findings and outcomes such as mortality and adverse events.

Main Methods:

• A comprehensive literature search of PubMed and EMBASE was conducted up to February 2014.
• Meta-regression analysis was used to derive risk estimates for quantitative and qualitative CT parameters, including right ventricular (RV) dysfunction and thrombus load.
• Studies reporting on the association between CT parameters and short-term (≤6 months) clinical outcomes in acute pulmonary embolism patients were included.

Main Results:

• The analysis included 49 studies with 13,162 patients diagnosed with acute pulmonary embolism via CT.
• An increased RV/left ventricular (LV) diameter ratio on transverse CT sections was linked to a 2.5-fold increased risk of all-cause mortality and a 5-fold increased risk of PE-related mortality.
• Thrombus load and central thrombus location were not predictive of all-cause mortality but showed association with adverse clinical outcomes.

Conclusions:

• The RV/LV diameter ratio measured on transverse CT sections demonstrates the strongest predictive value for adverse clinical outcomes in acute pulmonary embolism.
• This CT parameter is supported by the most robust evidence base for predicting outcomes in this patient population.