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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 1, January/February 2020
AFRICA
21
Relationship between clot burden in pulmonary computed
tomography angiography and different parameters of right
cardiac dysfunction in acute pulmonary embolism
Heba wagih Abdelwahab, Shreif Arafa, Khaled Bondok, Nihal Batouty, Mostafa Bakeer
Abstract
Background:
Pulmonary computed tomography angiogra-
phy (CTA) contains a wealth of information regarding the
diagnosis and impact of acute pulmonary embolism (PE).
Echocardiography remains the recommended examination to
detect signs of right ventricular (RV) dysfunction in patients
with shock or hypotension following PE.
Objectives:
To detect the relationship between clot volume
in pulmonary CTA and different parameters of RV dysfunc-
tion assessed by echocardiography and pulmonary CTA in
patients with acute PE.
Methods:
A cross-sectional study was performed on patients
with acute PE from June 2017 to June 2018. Enrolled
patients were assessed clinically, radiologically and for cardiac
dysfunction. The relationship between clot volume and RV
dysfunction was assessed using pulmonary CTA and echo-
cardiography. Data were analysed with SPSS version 16.
Correlations were studied using the Spearman and Kruskal–
Wallis tests.
Results:
There was a significant correlation found between
clot volume and parameters of RV dysfunction, assessed by
pulmonary CTA, including RV diameter (
p
<
0.001), RV to
left ventricular (LV) diameter ratio (
p
=
0.01), pulmonary
artery diameter (
p
=
0.01), ratio of main pulmonary artery to
ascending aorta diameter (
p
=
0.04), and superior vena cava
diameter (
p
=
0.01). On the other hand, there was no signifi-
cant correlation between clot volume and parameters of RV
dysfunction assessed by echocardiography.
Conclusion:
In patients with acute PE, the assessment of RV
dysfunction using pulmonary CTA showed good correlation
with clot burden, unlike the assessment done with echocar-
diography.
Keywords:
acute pulmonary embolism, clot burden, right ventric-
ular dysfunction
Submitted 29/9/18, accepted 8/7/19
Published online 30/8/19
Cardiovasc J Afr
2020;
31
: 21–24
www.cvja.co.zaDOI: 10.5830/CVJA-2019-041
Pulmonary computed tomography angiography (CTA) has been
established as the first-line imaging modality for the diagnosis
of acute pulmonary embolism (PE) in clinical practice.
1
In
addition to its role in diagnosis, pulmonary CTA contains a
wealth of information, such as characteristics of the clot, which
may be used as biomarkers to improve treatment and clinical
management.
2
Risk stratification for patients with acute PE is important
to establish the appropriate management.
3
Patients with PE
and preserved right ventricular (RV) function are treated with
systemic anticoagulation, while haemodynamically unstable
patients are considered to be candidates for thrombolytic
therapy.
4
Echocardiography is recommended as the first-line
examination in patients with shock or hypotension following
PE to detect signs of RV dysfunction. Pulmonary CTA, on the
other hand, is a commonly used technique for diagnosis of PE
and assessment of RV dysfunction, which would facilitate risk
stratification in all patients.
5
This study was planned to detect the
relationship between clot volume and different parameters of RV
dysfunction assessed by echocardiography and pulmonary CTA
in patients with acute PE.
Methods
A cross-sectional study was performed from June 2017 to June
2018. Seventy patients with acute PE admitted to the Chest
Medicine Department, Mansoura University, were enrolled in
this study. All patients provided written informed consent prior
to participation. The study was approved by the institutional
review board. Patients with inadequate pulmonary CTA scans
(poor imaging) were excluded. Any decision about treatment was
at the discretion of the attending physician.
Enrolled patients in this cross-sectional study were assessed
clinically and radiologically, as well as for cardiac dysfunction.
The clinical assessment was done using pulmonary embolism
severity index score:
6
class I: ≤ 65 points, very low risk; class II:
66–85 points, low risk; class III: 86–105 points, intermediate
risk; class IV: 106–125 points, high risk; class V: > 125 points,
very high risk.
Assessment of RV dysfunction
For pulmonary CTA, Philips Ingenuity core 128, the
Netherlands, and non-ionic iodinated contrast agent Iohexol
350 mgI/ml, Omnipaque, GE Health Care, Ireland, were used.
The imaging studies were analysed by a radiologist. PE was
assessed on pulmonary CTA images by detecting the presence
of an endoluminal central filling defect partially or completely
occluding the pulmonary arteries. We used a standardmediastinal
Chest Medicine Department, Mansoura University, Egypt
Heba wagih Abdelwahab, MD
Khaled Bondok, MSc
Mostafa Bakeer, MD,
mbekeer10@hotmail.comCardiology Department, Mansoura University, Egypt
Shreif Arafa, MD
Radiology Department, Mansoura University, Egypt
Nihal Batouty, MD