Publication
One-shot diagnostic and prognostic assessment in intermediate- to high-risk acute pulmonary embolism: The role of multidetector computed tomography
| dc.contributor.author | Baptista, R | |
| dc.contributor.author | Santiago, I | |
| dc.contributor.author | Jorge, E | |
| dc.contributor.author | Teixeira, R | |
| dc.contributor.author | Mendes, P | |
| dc.contributor.author | Curvo-Semedo, L | |
| dc.contributor.author | Castro, G | |
| dc.contributor.author | Monteiro, P | |
| dc.contributor.author | Caseiro-Alves, F | |
| dc.contributor.author | Providência, LA | |
| dc.date.accessioned | 2013-02-19T11:41:41Z | |
| dc.date.available | 2013-02-19T11:41:41Z | |
| dc.date.issued | 2013 | |
| dc.description.abstract | INTRODUCTION: Contrast-enhanced multidetector computed tomography (MDCT) is useful for the diagnosis of pulmonary embolism (PE). However, current guidelines do not support its use for risk assessment in acute PE patients. OBJECTIVES: We compared the prognostic impact of MDCT-derived indices regarding medium-term mortality in a population of intermediate- to high-risk PE patients, mostly treated by thrombolysis. METHODS: Thirty-nine consecutive patients admitted to an intensive care unit with acute PE were studied. All patients had a pulmonary MDCT on admission to the emergency room as part of the diagnostic algorithm. We assessed the following MDCT variables: right ventricular/left ventricular diameter (RV/LV) ratio, arterial obstruction index, pulmonary artery-to-aorta diameter ratio and azygos vein diameter. A 33-month follow-up was performed. RESULTS: Mean age was 59.1±19.6 years, with 80% of patients receiving thrombolysis. Follow-up all-cause mortality was 12.8%. Of the MDCT-derived variables, only the RV/LV ratio had significant predictive value, being higher in patients who suffered the endpoint (1.6±0.5 vs. 1.9±0.4, p=0.046). Patients with an RV/LV ratio ≥1.8 had 11-fold higher medium-term all-cause mortality (3.8% vs. 38.8%, p<0.001). Regarding this endpoint, the c-statistic was 0.78 (95% CI, 0.60-0.96) for RV/LV ratio and calibration was good (goodness-of-fit p=0.594). No other radiological index was predictive of mortality. CONCLUSIONS: MDCT gives the possibility, in a single imaging procedure, of diagnosing and assessing the prognosis of patients with intermediate- to high-risk PE. Although further studies are needed, the simple-to-calculate RV/LV ratio has good discrimination and calibration for predicting poorer outcomes in patients with acute PE. | por |
| dc.identifier.citation | Rev Port Cardiol. 2013;32(1):7-13. | por |
| dc.identifier.uri | http://hdl.handle.net/10400.4/1502 | |
| dc.language.iso | eng | por |
| dc.peerreviewed | yes | por |
| dc.publisher | Sociedade Portuguesa de Cardiologia | por |
| dc.subject | Embolia Pulmonar | por |
| dc.subject | Tomografia Computorizada | por |
| dc.title | One-shot diagnostic and prognostic assessment in intermediate- to high-risk acute pulmonary embolism: The role of multidetector computed tomography | por |
| dc.type | journal article | |
| dspace.entity.type | Publication | |
| rcaap.rights | openAccess | por |
| rcaap.type | article | por |