Assessment of Right Ventricular Function in Acute Pulmonary Embolism Using ECG-Synchronized MDCT

OBJECTIVE: The purpose of this article is to determine the independent predictors of right ventricular (RV) dysfunction in patients with acute pulmonary embolism (PE) and to assess the relationship between RV ejection fraction (EF) and PE load.

METHODS: Breath-hold CT of the chest was performed for 64 patients with PE (33 men and 31 women; mean [± SD] age, 58.6 ± 16.5 years). In addition, ECG-synchronized cardiac CT was performed to determine the RV and left ventricular (LV) EFs. PE load was determined using the Qanadli obstruction index. Multivariable regression analysis was performed to determine independent predictors of RV dysfunction (defined as EF < 35%). In addition, the relationship between RV EF and PE load was assessed by receiver operating characteristic (ROC) curves.

RESULTS: RV dysfunction was independently predicted by a PE load greater than 50% (odds ratio, 40.17; 95% CI, 4.22-382.67) and an LV EF less than 45% (odds ratio, 31.18; 95% CI, 2.00-487.09; p < 0.05 for both). Curve analysis revealed that a PE load greater than 50% had a sensitivity of 82% and a specificity of 85% to identify an RV EF less than 35%. Conversely, an RV EF less than 35% had a sensitivity of 93% and a specificity of 67% to predict a PE load greater than 50%.

CONCLUSIONS: RV dysfunction (defined as RV EF < 35%) in patients with acute PE is highly sensitive to define a PE load greater than 50%. Furthermore, RV dysfunction is independently predicted by an obstruction index greater than 50% or an LV EF less than 45%. Assessment of RV function by ECG-synchronized CT may become useful for guiding therapy. Tyus Bowser Authentic Jersey

PMID: 20858817

Posted in Computed Tomography and tagged , , , .

One Comment

  1. Interesting analysis that shows that ECG gated CT can be used to both assess PE burden as well as cardiac function simultaneously.

    The suggestion that this type of exams may be useful in the future remains in my opinion premature as there is no outcome data to suggest that this is better than the conventional un-gated CTA of the chest.
    Additionally, the much larger radiation dose required in this type of exam makes it less likely to gain momentum. Consider the large number of negative for PE CTA examinations ordered in every ED in the country…

Leave a Reply

Your email address will not be published. Required fields are marked *