Prognostic Value of Right Ventricular Dysfunction and Pulmonary Obstruction Index by Computed Tomographic Pulmonary Angiography in Patients with Acute Pulmonary Embolism
Narumol Chaosuwannakit MD*, Pattarapong Makarawate MD**
Affiliation : * Radiology Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand ** Cardiology Unit, Internal Medicine Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Objective : To quantify right ventricular dysfunction (RVD) and pulmonary obstruction index assessed by computed
tomographic pulmonary angiography (CTPA) to assess the predictive value of these CT parameters for mortality after the
initial diagnosis of acute pulmonary embolism (APE).
Material and Method: In 81 consecutive patients with proved APE, two readers assessed the extent of RVD, the shape of
the interventricular septum, and the extent of obstruction to the pulmonary artery on CTPA images. The readers were blinded
for clinical outcome in consensus reading.
Results : During follow-up, 20 patients died (25%). CT signs of RVD (RV/LV ratio > 1.0) were seen in 47 patients (58%).
The RV/LV ratio, the shape of interventricular septum, and the obstruction index were shown to be significant risk factors
for mortality ( p < 0.001, p = 0.04, p < 0.001, respectively). The negative predictive value for mortality with an RV/LV ratio
≤ 1.0 and the obstruction index of < 40% were 100%.
Conclusion : CTPA quantification of RVD and pulmonary vascular obstruction index are potential useful tools to predict
mortality in patients with APE.
Keywords : Acute pulmonary embolism, CTPA, Right ventricular dysfunction, Pulmonary obstruction index
