COMMENTARY

Acute Pulmonary Embolism and Short-term Mortality

Hossein Jadvar, MD, PhD, MPH, MBA

Disclosures

November 12, 2012

Short-term Mortality in Acute Pulmonary Embolism: Clot Burden and Signs of Right Heart Dysfunction at CT Pulmonary Angiography

Furlan A, Aghayev A, Chang CC, et al
Radiology. 2012;265:283-293

Summary

The aim of this retrospective investigation was to assess the correlation between short-term mortality (within 30 days) and volumetric measurements of clot, semiquantitative clot burden indexes (Qanadli score and Mastora score), and signs of right heart dysfunction obtained from CT pulmonary angiography in 635 patients with acute pulmonary embolism (PE). The study authors found that greater clot volume was associated with a higher incidence of right heart dysfunction, and that a right ventricle (RV) to left ventricle (LV) ratio that is greater than 1.0 was independently associated with short-term mortality. Additionally, although clot volume was also associated with the Qanadli score (ρ = 0.841, P < .01) and Mastora score (ρ = 0.863, P < .01) of clot burden, the latter scores were not correlated with short-term mortality.

Viewpoint

Acute PE may be associated with a high risk for mortality. Appropriate treatment may involve a spectrum from outpatient anticoagulation to close monitoring and thrombolytic treatment in the intensive care unit.[1] Therefore, prognostic stratification of patients with PE based on mortality risk is an important goal.[2] Risk predictors may include clinical, laboratory, and imaging parameters.[3,4] This investigation from the University of Pittsburgh deciphered whether several parameters derived from CT pulmonary angiography in patients with PE may serve as predictors of short-term mortality.

Most patients were inpatients (80%) with a significant rate of comorbidities, including cancer, congestive heart failure, myocardial infarction, chronic lung disease, chronic renal disease, and cerebrovascular disease. In fact, it was noted in the multivariate analysis that not only was the increase in RV/LV ratio independently associated with short-term mortality, but so was history of congestive heart failure or cancer. Nevertheless, this study provided important information on how simple, imaging-based parameters obtained from CT pulmonary angiography may be used to guide clinical decision-making.

Abstract

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