RADIOLOGICAL ASSESSMENT OF RIGHT HEART STRAIN AND PULMONARY EMBOLISM SEVERITY USING CTPA METRICS
Journal
KNOWLEDGE- International Journal
Date Issued
2024-03
Author(s)
Abstract
Abstract: Pulmonary thromboembolism (PTE) poses a significant risk of acute right-sided heart failure and
mortality. Computed tomography pulmonary angiography (CTPA) serves as the gold standard for assessing acute
pulmonary embolism (APE) risk. This study aims to determine the potential risk of acute right-sided heart failure in
APE patients through semi-quantitative CTPA measurements, including the pulmonary arterial obstruction index
(PAOI) and evaluation of right atrium (RA) dimensions, left atrium (LA) dimensions, RA/LA ratio, and inferior
vena cava (IVC) contrast reflux.
Method: This retrospective study involved 50 patients, undergoing initial and follow-up CTPA’s at the Institute of
Radiology in Skopje, between January 2018 and January 2021, who were initially diagnosed with APE. They all
exhibited varied degrees of pulmonary arterial obstruction index, constituting the study group, while their follow-up
CT’s after treatment and resolution of emboli, comprised the control group. PAOI was semi-quantitatively
correlated with RA and LA dimensions, RA/LA ratio, and IVC contrast reflux using axial CT scans on the initial
and follow up CTPA’s.
Results: Among the 50 APE patients, 31 were male and 19 were female. Significant positive correlations were
observed between PAOI and RA short axis, RA/LA short and long axis ratio, and IVC contrast reflux. Conversely,
negative correlations were found between PAOI and LA dimensions.
Discussion: The correlations observed between PAOI measurements and cardiac dimensions in APE patients shed
light on the condition's hemodynamic implications. A negative correlation with left atrium dimensions suggests
reduced left ventricular preload with increasing pulmonary arterial obstruction. Conversely, positive correlations
with right atrium dimensions and RA/LA ratio underscore the impact of elevated pulmonary vascular resistance on
right heart strain, indicating a heightened risk of right-sided heart failure.
The association between PAOI and IVC contrast reflux highlights the significance of venous congestion in APE,
further exacerbating right heart strain. These findings emphasize the importance of assessing right heart dimensions
and venous congestion in APE prognosis. PAOI, along with these parameters, serve as valuable prognostic
indicators, aiding in risk stratification and guiding therapeutic decisions to minimize adverse outcomes in APE
patients.
Conclusion: PAOI measurements, IVC contrast reflux, RA short axis, and RA/LA short and long axis ratio serve as
reliable CT prognostic markers for APE severity, risk of right-sided heart failure, and adverse outcomes. These
markers aid in timely diagnosis and therapy selection for APE patients.
Keywords: Acute pulmonary embolism (APE), Pulmonary arterial obstruction index (PAOI), Right heart failure
(RHF), Right atrium (RA), Inferior vena cava contrast reflux (IVC), Computed Tomography Pulmonary
Angiography (CTPA).
mortality. Computed tomography pulmonary angiography (CTPA) serves as the gold standard for assessing acute
pulmonary embolism (APE) risk. This study aims to determine the potential risk of acute right-sided heart failure in
APE patients through semi-quantitative CTPA measurements, including the pulmonary arterial obstruction index
(PAOI) and evaluation of right atrium (RA) dimensions, left atrium (LA) dimensions, RA/LA ratio, and inferior
vena cava (IVC) contrast reflux.
Method: This retrospective study involved 50 patients, undergoing initial and follow-up CTPA’s at the Institute of
Radiology in Skopje, between January 2018 and January 2021, who were initially diagnosed with APE. They all
exhibited varied degrees of pulmonary arterial obstruction index, constituting the study group, while their follow-up
CT’s after treatment and resolution of emboli, comprised the control group. PAOI was semi-quantitatively
correlated with RA and LA dimensions, RA/LA ratio, and IVC contrast reflux using axial CT scans on the initial
and follow up CTPA’s.
Results: Among the 50 APE patients, 31 were male and 19 were female. Significant positive correlations were
observed between PAOI and RA short axis, RA/LA short and long axis ratio, and IVC contrast reflux. Conversely,
negative correlations were found between PAOI and LA dimensions.
Discussion: The correlations observed between PAOI measurements and cardiac dimensions in APE patients shed
light on the condition's hemodynamic implications. A negative correlation with left atrium dimensions suggests
reduced left ventricular preload with increasing pulmonary arterial obstruction. Conversely, positive correlations
with right atrium dimensions and RA/LA ratio underscore the impact of elevated pulmonary vascular resistance on
right heart strain, indicating a heightened risk of right-sided heart failure.
The association between PAOI and IVC contrast reflux highlights the significance of venous congestion in APE,
further exacerbating right heart strain. These findings emphasize the importance of assessing right heart dimensions
and venous congestion in APE prognosis. PAOI, along with these parameters, serve as valuable prognostic
indicators, aiding in risk stratification and guiding therapeutic decisions to minimize adverse outcomes in APE
patients.
Conclusion: PAOI measurements, IVC contrast reflux, RA short axis, and RA/LA short and long axis ratio serve as
reliable CT prognostic markers for APE severity, risk of right-sided heart failure, and adverse outcomes. These
markers aid in timely diagnosis and therapy selection for APE patients.
Keywords: Acute pulmonary embolism (APE), Pulmonary arterial obstruction index (PAOI), Right heart failure
(RHF), Right atrium (RA), Inferior vena cava contrast reflux (IVC), Computed Tomography Pulmonary
Angiography (CTPA).
File(s)![Thumbnail Image]()
Loading...
Name
KNOWLEDGE – International Journal Vol.63, trud Sonja.pdf
Size
1.18 MB
Format
Adobe PDF
Checksum
(MD5):39f35f164c6a15f899e822beb7bf2867