Prognostic value of computed tomography pulmonary angiography indices in patients with cancer-related pulmonary embolism: Data from a multicenter cohort study. Issue 87 (February 2017)

• Record Type: Journal Article
• 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;
• Is Part Of: European journal of radiology. Issue 87(2017)
• Page Start: 66
• Page End: 75
• Publication Date: 2017-02
• Subjects: PE pulmonary embolism -- CT computed tomography -- CTPA computed tomography pulmonary angiography -- RV right ventricle -- LV left ventricle -- RV/LV right ventricular to left ventricular ratio -- IVS interventricular septum -- QI Qanadli pulmonary arterial obstruction index -- CPHT chronic pulmonary hypertension -- PA pulmonary artery -- AA ascending aorta -- IVC inferior vena cava -- SVC superior vena cava -- Az azigos vein -- CI confidence interval -- IQR interquartile range -- Std. Error standard error -- ROI region of interest -- HU Hounsfield units -- SaO2 arterial oxygen saturation; Prognosis -- Pulmonary embolism -- Tumor -- Multidetector computed tomography -- Right ventricular dysfunction; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2016.12.010
• Languages: English
• ISSNs: 0720-048X

Abstract

Graphical abstract: Highlights: CTPA can predict the prognosis of pulmonary embolism in cancer patients. Right ventricular dysfunction (RVD) is predictive of complications at 15 days. 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. Abstract: Objective: To analyze the prognostic value of pulmonary artery obstruction versus right-ventricle (RV) dysfunction radiologic indices in cancer-related pulmonary embolism (PE). Methods: 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 15 days. 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. Results: RV diameter was the only radiological variable associated with an adverse outcome. Subjects with enlarged RV (diameter > 45 mm) 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. Conclusions: Right ventricular dysfunction signs in CTPA are more useful than QI in predicting cancer-related PE outcome.