RV size may predict death in unstable patients with PE

Area of Science:

• Cardiology
• Radiology
• Critical Care Medicine

Background:

• Acute pulmonary embolism (PE) is a life-threatening condition.
• Massive PE can lead to hemodynamic collapse and right ventricular (RV) dysfunction, increasing mortality risk.
• Many PE cases are only discovered post-mortem.

Purpose of the Study:

• To evaluate the predictive ability of RV dimensions from non-gated CT pulmonary angiography (CTPA) for in-hospital mortality in acute PE patients.
• To identify clinical and hematological predictors of death in acute PE.

Main Methods:

• Retrospective cohort study of 300 patients with acute PE (2012-2017).
• Analysis of non-gated CTPA images to measure RV dimensions.
• Comparison of outcomes between patients admitted to intensive care units (ICUs) and internal medicine wards.

Main Results:

• In the ICU cohort (45 patients), 8% mortality was observed. Larger RV diameters (OR=10.14) and lower blood pressure predicted death.
• In the internal medicine ward cohort (255 patients), 7% mortality was observed. Older age, sepsis, cancer, high WBC count, and renal failure predicted death.
• Lower systolic and diastolic blood pressure, older age, sepsis, cancer, elevated WBC count, and renal failure were significant predictors of death across the PE cohort.

Conclusions:

• Clinical and hematological parameters effectively predict mortality in acute PE.
• Non-ECG gated CTPA measurement of RV diameter provides additive predictive value for mortality in ICU patients with acute PE.