Purpose: Though increased right ventricular (RV) to left ventricular (LV) diameter ratio is considered a marker of increased risk among patients with pulmonary embolism (PE), it is known to have weak positive predictive value for mortality. Our aim was to investigate the ability of cardiac chambers` diameters, and volumes to predict mortality among patients with and without PE.
Materials and Methods: We retrospectively analyzed 1006 consecutive patients who underwent non-gated CTPA for suspected PE between 1.1.2014 and 31.12.2014. We measured the diameter of the RV, LV and the volumes of the RV, LV, left atrium (LA) and right atrium (RA), using automatic volumetric analysis software with correction to body surface area (BSA). Each parameter was categorized by division into tertiles. The association between the RV/LV diameter ratio and the chambers` volumes with mortality in 30 days was investigated after adjustment to age, gender and background diseases, using logistic regression.
Results: The final cohort included 862 patients with complete data, 142 (16.5%) of them had PE by CTPA. 98 patients (11.4%) died within 30 days of the CTPA date, 17 (12.0%) with PE, and 81 (11.2%) without it (p>0.05). RV diameters and volumes in the highest tertile were more common in patients with PE non-PE patients (31.7% vs 16%, P=0.001 for diameters, and 26.1% vs 17.1%. P=0.041, for volumes, respectively). In addition, the LA volumes were more often in the lowest tertile among the PE patients compared to non- PE patients (22.5% vs 19.6%, P=0.032). Following logistic regression, higher risk for 30-day mortality was found among patients with PE who had low LA and LV volumes (OR=15.3, P=0.003, OR=9.4, P=0.017 for LV). Similar results with a weaker statistical strength were found among patients without PE (OR=2.4, P=0.012 for LA, OR=1.88, P= 0.039 for LV). RV/LV diameter ratio and RV volumes did not correlate with mortality (non-significant among all groups).
Conclusions: Although the RV diameters and volumes of PE patients were more commonly within the highest tertiles, mortality in 30 days among patients with and without PE undergoing CTPA, was associated with decrease in the LA and LV volumes. Further studies are required to evaluate the positive and negative predictive values of decreased LA and LV volumes for prediction of mortality among PE and non-PE patients.
