Acute Pulmonary Embolism among Patients with and without Malignancy: Comparison of Cardiac Measurements Using CT Pulmonary Angiography

Purpose: Pulmonary embolism (PE) in patients with malignancy is highly prevalent but its specific clinical and computed tomography pulmonary angiogram (CTPA) characteristics are not well known. Our aim was to use a novel automatic analysis software of CTPA exams and to compare among patients with acute PE, the cardiac chambers’ measurements, between patients with and without malignancy, and their correlation to short term mortality.

Methods and Materials: Retrospective analysis of 636 consecutive patients diagnosed with acute PE by CTPA between 1/2007-12/2010. Each CTPA was assessed for thrombi distribution (central vs. peripheral), the diameters of the ventricles (measured manually) and volumes of the four cardiac chambers (using automatic software). Multivariate logistic regression adjusted to age, gender and co-morbidities was used to assess the association between CT measurements and 30-days mortality in patients with and without malignancy.

Results: Two-hundred nineteen patients (34%) had malignancy. Thrombi distribution was not different (p=0.25). Patients with malignancy had higher rates of mortality (27% vs. 6%, respectively, p<0.001).Mortality was higher when left atrial volume was less than 62 ml(OR 2.47, CI [1.33-4.60]; p=0.004) among patients with malignancy, and when right to left ventricular (RV/LV) volume ratio was more than 1.52 among patients without malignancy (OR 6.48, CI[1.46-28.79]; p=0.01), and did not correlate to the RV/LV diameter ratio in both groups.

Conclusion: Short term mortality among acute PE patients with and without malignancy seems to be associated with different cardiac characteristics, obtained by a novel fully automatic analysis of CTPA exams. These findings suggest the need for differential risk stratification among these two distinct groups.