Prognostic value of CT pulmonary angiography parameters in acute pulmonary embolism

Objectives Computed tomographic pulmonary angiography (CTPA) is the frst-line test in acute pulmonary embolism (APE) diagnostic algorithm, but its correlation with short-term outcome remains not clear at all. The aim is to determine whether CTPA fndings can predict 30-day mortality of patients with APE in Emergency Department. Methods This retrospective monocentric study involved 780 patients with APE diagnosed at the Emergency Department of our institution (period 2010–2019). These CTPA fndings were evaluated: embolic obstruction burden score (Qanadli score), common pulmonary artery trunk diameter, right-to-left ventricular ratio, azygos vein and coronary sinus diameters. Comorbidities and fatal/nonfatal adverse outcomes within 30 days were recorded. Troponin I values were correlated with angiographic parameters with multiple logistic regression analysis. Results The all-cause and APE-related 30-day mortality rates were 5.9% and 3.6%, respectively. Patients who died within 30 days were older with higher prevalence rates of malignancy. Qanadli score and all CTPA parameters correlate with Troponin I level and the presence of RVD at echocardiography (p values<0.0001). Instead, RV/LV ratio and coronary sinus diameter correlate with 30-day mortality (p values<0.05). At the multivariate logistic regression analysis, only coronary sinus and RVD remained signifcant with an HR=2.5 (95% CI 1.1–5.6) and HR=1.9 (95% CI 0.95–3.7), respectively. Conclusion CTPA quantifcation of right ventricular strain is an accurate predictor of 30-day mortality. In particular, it seems that a dilated coronary sinus (>9 mm) has an additional prognostic value in association with echocardiographic signs of right-heart disfunction and high Troponin I levels.