EVALUATION OF THE RELATIONSHIP BETWEEN PULMONARY ARTERIAL OBSTRUCTION INDEX AND SEVERAL CT MARKERS OF RIGHT VENTRICULAR DYSFUNCTION IN PATIENTS WITH ACUTE PULMONARY EMBOLISM

Abstract

Introduction: Pulmonary thromboembolism (PTE) ranks third in mortality among the most common cardiovascular diseases. Usual cause of death in acute pulmonary embolism (APE) patients is development of right ventricular dysfunction (RVD). Aim: The study aimed to evaluate the relationship between pulmonary arterial obstruction index (PAOI) and several computed tomographic (CT) markers of right ventricular dysfunction (RVD), using computed tomographic pulmonary angiography (CTPA) in patients with acute pulmonary embolism (APE). Material and methods: We evaluated the initial and follow-up CTPAs of 22 patients with acute pulmonary embolism (APE) from January 2017 to January 2018, who had previous echocardiographic examination. We calculated the pulmonary arterial obstruction index (PAOI) and several CT markers of right ventricular dysfunction (RVD), then made a comparison with the echocardiographic findings in order to detect patients with acute pulmonary hypertension (PAH) and right ventricular dysfunction (RVD). All patients underwent CTPA according to appropriate diagnostic protocol for acute pulmonary embolism (APE) on a 64-slice Somatom Definition AS + computed tomography (Siemens Healthineers, USA). Results: There was a strong and statistically significant positive correlation between the pulmonary arterial obstruction index and the right ventricular diameter as well as the PAOI and the right and left ventricular diameter ratio, on the first and follow-up measurements (r=0 .5306, p=0.011 and r=0.5359, p=0.010; r=0.5568, p=0.007 and r=0.6077, p=0.003). Conclusion: The semi-quantitative measurements of pulmonary arterial obstruction index (PAOI) acquired on CTPA not only enable thrombi quantification, but also risk stratification for undesirable outcomes. Such and similar studies can aid the selection of appropriate CT protocols for acute pulmonary embolism (APE) diagnosis and appropriate therapy selection, as well as the avoidance of additional and unnecessary diagnostic examinations.