Prognostic value of computed tomography pulmonary angiography indices in patients with cancer-related pulmonary embolism: Data from a multicenter cohort study

• Published in: European journal of radiology Vol. 87; pp. 66 - 75
• Main Authors: Plasencia-Martínez, Juana María, Carmona-Bayonas, Alberto, Calvo-Temprano, David, Jiménez-Fonseca, Paula, Fenoy, Francisco, Benegas, Mariana, Sánchez, Marcelo, Font, Carme, Varona, Diego, Martínez de la Haza, David, Pueyo, Jesús, Biosca, Mercè, Antonio, Maite, Beato, Carmen, Solís, Pilar, Fáez, Laura, de al Haba, Irma, Hernández-Muñiz, Susana, Madridano, Olga, Martín, Mar, Castañón, Eduardo, Ramchandani, Avinash, Marchena, Pablo, Sánchez-Cánovas, Manuel, Vicente, María Ángeles, Martínez, Mari José, Fernández-Plaza, Ángela, Martínez-Encarnación, Lourdes, Puerta, Alejandro, Domínguez, Ángel, Rodríguez, Daniel, Marín, Gema, Otero, Remedios, Sánchez-Lasheras, Fernando, Vicente, Vicente
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.02.2017
• Subjects: Adult; Aged; Aged, 80 and over; Computed Tomography Angiography - methods; Female; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Male; Middle Aged; Multidetector computed tomography; Neoplasms - complications; Prognosis; Pulmonary Artery - diagnostic imaging; Pulmonary embolism; Pulmonary Embolism - complications; Pulmonary Embolism - diagnostic imaging; Radiology; Reproducibility of Results; Retrospective Studies; Right ventricular dysfunction; Tumor; Ventricular Dysfunction, Right - complications; Ventricular Dysfunction, Right - diagnostic imaging; Ventricular Dysfunction, Right - physiopathology; SVC; Prognosis; RV; IVS; LV; HU; Std. Error; SaO2; QI; Az; Tumor; RV/LV; Right ventricular dysfunction; AA; CPHT; CI; IQR; ROI; Multidetector computed tomography; Pulmonary embolism; CT; PA; PE; IVC; CTPA; computed tomography pulmonary angiography; pulmonary artery; azigos vein; left ventricle; arterial oxygen saturation; chronic pulmonary hypertension; interquartile range; SaO 2; right ventricular to left ventricular ratio; pulmonary embolism; computed tomography; standard error; interventricular septum; Qanadli pulmonary arterial obstruction index; inferior vena cava; right ventricle; region of interest; superior vena cava; confidence interval; Hounsfield units; ascending aorta
• ISSN: 0720-048X; 1872-7727; 1872-7727
• DOI: 10.1016/j.ejrad.2016.12.010

[Display omitted] •CTPA can predict the prognosis of pulmonary embolism in cancer patients.•Right ventricular dysfunction (RVD) is predictive of complications at 15days.•The Frank-Starling mechanism is the theoretical framework to interpret RVD signs.•Pulmonary artery obstruction plays a pathophysiological role only in subjects with RVD.•A proposal for an explanation of clinical-radiological dissociation is presented. To analyze the prognostic value of pulmonary artery obstruction versus right-ventricle (RV) dysfunction radiologic indices in cancer-related pulmonary embolism (PE). We enrolled 303 consecutive patients with paraneoplastic PE, evaluated by computed tomography pulmonary angiography (CTPA) between 2013 and 2014. The primary outcome measure was serious complications at 15days. Multivariate analyses were conducted by using binary logistic and robust regressions. Radiological features such as the Qanadli index (QI) and RV dysfunction signs were analyzed with Spearman’s partial rank correlations. RV diameter was the only radiological variable associated with an adverse outcome. Subjects with enlarged RV (diameter>45mm) had more 15-day complications (58% versus 40%, p=0.001). The QI correlated with the RV diameter (r=0.28, p<0.001), left ventricle diameter (r=−0.19, p<0.001), right ventricular-to-left ventricular diameter ratio (r=0.39, p<0.001), pulmonary artery diameter (r=0.22, p<0.001), and pulmonary artery/ascending aorta ratio (r=0.27, p<0.001). A QI≥50% was only associated with 15-day complications in subjects with enlarged RV, inverted intraventricular septum, or chronic cardiopulmonary diseases. The central or peripheral PE location did not affect the correlations among radiological variables and was not associated with clinical outcomes. Right ventricular dysfunction signs in CTPA are more useful than QI in predicting cancer-related PE outcome.