CT imaging determinants of persistent hypoxemia in acute intermediate-risk pulmonary embolism

• Published in: Journal of thrombosis and thrombolysis Vol. 56; no. 1; pp. 196 - 201
• Main Authors: Hassan, Syed Moin, Nardelli, Pietro, Minhas, Jasleen K., Ash, Samuel Y., Estépar, Rubén San José, Antkowiak, MaryEllen C., Badlam, Jessica B., Piazza, Gregory, Estépar, Raúl San José, Washko, George R., Rahaghi, Farbod N.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.07.2023; Springer Nature B.V
• Subjects: Aorta; Cardiology; Computed tomography; Diagnosis; Embolism; Heart; Hematology; Hypoxemia; Lung diseases; Medicine; Medicine & Public Health; Oxygen; Pulmonary arteries; Pulmonary artery; Pulmonary embolisms; Ventricle; PE prognostication; Hypoxemia; Vascular reconstructions; Acute pulmonary embolism; Persistent hypoxemia; Vascular pruning; Right ventricular dysfunction
• ISSN: 1573-742X; 0929-5305; 1573-742X
• DOI: 10.1007/s11239-023-02813-x

The factors associated with persistent hypoxemia after pulmonary embolus (PE) are not well understood. Predicting the need for oxygen post discharge at the time of diagnosis using available CT imaging will enable better discharge planning. To examine the relationship between CT derived imaging markers (automated computation of arterial small vessel fraction, pulmonary artery diameter to aortic diameter ratio (PA:A), right to left ventricular diameter ratio (RV:LV) and new oxygen requirement at the time of discharge in patients diagnosed with acute intermediate-risk PE. CT measurements were obtained in a retrospective cohort of patients with acute-intermediate risk PE admitted to Brigham and Women’s Hospital between 2009 and 2017. Twenty one patients without a history of lung disease requiring home oxygen and 682 patients without discharge oxygen requirements were identified. There was an increased median PA:A ratio (0.98 vs. 0.92, p  = 0.02) and arterial small vessel fraction (0.32 vs. 0.39, p  = 0.001) in the oxygen-requiring group], but no difference in the median RV:LV ratio (1.20 vs. 1.20, p  = 0.74). Being in the upper quantile for the arterial small vessel fraction was associated with decreased odds of oxygen requirement (OR 0.30 [0.10–0.78], p  = 0.02). Loss of arterial small vessel volume as measured by arterial small vessel fraction and an increase in the PA:A ratio at the time of diagnosis were associated with the presence of persistent hypoxemia on discharge in acute intermediate-risk PE.