Right Ventricular Enlargement on Chest Computed Tomography: Prognostic Role in Acute Pulmonary Embolism

Abstract

Background— We investigated the prognostic role of right ventricular enlargement on multidetector-row chest CT in acute pulmonary embolism (PE). Methods and Results— We studied 63 patients with CT-confirmed PE who underwent echocardiography within the ensuing 24 hours. Adverse clinical events, defined as 30-day mortality or the need for cardiopulmonary resuscitation, mechanical ventilation, pressors, rescue thrombolysis, or surgical embolectomy, were present in 24 patients. We performed off-line CT measurements of right and left ventricular dimensions (RV D , LV D ) with axial and 2-dimensional reconstructed 4-chamber (4-CH) views. The proportion of patients with RV D /LV D >0.9 on the axial view was similar in patients with (70.8%) and those without adverse events (71.8%; P =0.577). In contrast, RV D /LV D >0.9 on the 4-CH view was more common in patients with (80.3%) than without (51.3%; P =0.015) adverse events. The area under the curve of RV D /LV D from the axial and 4-CH views for predicting adverse events was 0.667 and 0.753, respectively. Sensitivity and specificity of RV D /LV D >0.9 for predicting adverse events were 37.5% and 92.3% on the axial view and 83.3% and 48.7% on the reconstructed 4-CH view, respectively. RV D /LV D >0.9 on the 4-CH view was an independent predictor for adverse events (OR, 4.02; 95% CI, 1.06 to 15.19; P =0.041) when adjusted for age, obesity, cancer, and recent surgery. Conclusions— Right ventricular enlargement on the reconstructed CT 4-CH views predicts adverse clinical events in patients with acute PE. Ventricular CT measurements obtained from 4-CH views are superior to those from axial views for identifying high-risk patients.