Application of a new pulmonary artery obstruction score in the prognostic evaluation of acute pulmonary embolism: comparison with clinical and haemodynamic parameters

• Published in: Radiologia medica Vol. 116; no. 2; pp. 230 - 245
• Main Authors: Attinà, D., Valentino, M., Galiè, N., Modolon, C., Buia, F., de Luca, F., Bacchi-Reggiani, M.L., Zompatori, M.
• Format: Journal Article
• Language: English; Italian
• Published: Milan Springer Milan 01.03.2011
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Angiography - methods; Chest Radiology; Chi-Square Distribution; Contrast Media; Diagnostic Radiology; Female; Humans; Imaging; Interventional Radiology; Iopamidol - analogs & derivatives; Male; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Predictive Value of Tests; Prognosis; Pulmonary Artery - diagnostic imaging; Pulmonary Artery - pathology; Pulmonary Embolism - diagnostic imaging; Pulmonary Heart Disease - diagnostic imaging; Pulmonary Heart Disease - pathology; Radiologia Toracica; Radiology; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Severity of Illness Index; Statistics, Nonparametric; Tomography, X-Ray Computed - methods; Ultrasound; Pulmonary embolism; Stratificazione del rischio; Indice di ostruzione arteria polmonare; Computed tomography; Pulmonary artery obstruction index; Risk stratification; Angio-TC; Embolia polmonare
• ISSN: 0033-8362; 1826-6983
• DOI: 10.1007/s11547-010-0613-1

Purpose Evaluation of computed tomography (CT) pulmonary angiography parameters revealing pulmonary embolism (PE) severity with particular attention to pulmonary obstruction indexes. Comparison with clinical and hemodynamic data and determination of predictive role in the development of chronic pulmonary heart disease. Materials and methods This retrospective study analyzes 45 not consecutive patients from November 2007 to December 2008 with CT angiography diagnosis of acute PE. Included in the study are patients at the first documented episode of acute PE, with 6 month follow-up. Patients with severe pre-existent cardiopulmonary pathology or neoplastic diseases were excluded from the study. CT angiography evaluated right ventricular (RV)/left ventricular (LV) ratio, obstruction index according to Qanadli and Total Clot Burden (Ghanima score). PE indexes were compared with Troponin I measurement and echocardiography result; at last hospitalization and intensive care time were reported. Results A significant association was found between Ghanima and Qanadli score: the two indexes are equivalent in quantification of pulmonary arterial obstruction (p<0.001). Among others CT parameters, the new Ghanima score evidenced the best accuracy to detect patients evolving to chronic pulmonary heart disease (76%). This value is higher than that of echocardiography (71%). Troponins showed highest accuracy (82%). Conclusions Ghanima score can be used in emergency CT angiography diagnosis as prognostic marker for a quickly risk stratification of pulmonary heart disease or death in patients with acute PE. This approach allows to obtain, with just one test, both the diagnosis and a rather accurate acute PE risk stratification.