Purpose: Right ventricular (RV) enlargement manifested as increased ratio between the right and left ventricular (LV) diameters ≥1 is considered an important imaging marker of increased mortality risk among patients diagnosed with acute pulmonary embolism (PE). Our goal was to assess the prevalence of increased RV/LV diameter and volumetric ratio among consecutive patients undergoing CT pulmonary angiography (CTPA), and to compare the prevalence of RV/LV≥1 between patients with and without PE.
Materials and Methods: We retrospectively analyzed 1006 consecutive patients who underwent non-gated CTPA due to clinical suspicion of PE between 1.1.2014 and 31.12.2014. Each CTPA was investigated by measuring the axial diameter of the RV and the LV and their volumes using an automatic four chamber volumetric analysis (4CVA) software
Results: The final cohort included 862 patients with complete data, 344 males (39.9%), median age 70 (58-82 inter-quarterial range). 142 (16.5%) of them had PE by CTPA. Diameter ratio of the RV/LV ≥1 was found in 553 (64.2%) of all patients, of them in 453 (63.3%) patients without PE and in 100 (70.4%) patients with PE (p=0.117). Volumetric ratio of RV/LV ≥1 was found in 796 (92.3%) of total patients, of them in 660 (91.7%) in the no-PE group and 136 (95.8%) in the PE group (p=0.092). On multivariate analysis, RV/LV≥1 of both diameter and volume showed a tendency of being more prevalent among patients with PE, but without a statistical significance (OR=1.6 {0.6-3.8 95% CI}, Pv=0.29 for volume, OR=1.29 {0.8-1.9 95% CI}, Pv=0.224 for diameter).
Conclusions: Diameter ratio of the RV/LV ≥1 is highly prevalent (64.7%) among patients undergoing CTPA, without a significance difference between those with and without PE. RV/LV ≥1 appears to be a limited marker of increased risk in PE, since it is highly prevalent in all patients undergoing CTPA. This factor should be considered when performing risk stratification.
