Thrombus load and acute right ventricular failure in pulmonary embolism: correlation and demonstration of a "tipping point" on CT pulmonary angiography

L. F. Wong, A. R. Akram, S. Mcgurk, E. J. R. Van Beek, J. H. Reid, J. T. Murchison

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: The aim of this study was to determine the correlation between increasing pulmonary embolism thrombus load and right ventricular (RV) dilatation as demonstrated by CT pulmonary angiography (CTPA) and to assess the thrombus load threshold which indicates impending RV decompensation.

Methods: 2425 consecutive CTPAs were retrospectively analysed. Thrombus load using a modified Miller score (MMS), RV to left ventricular (RV:LV) ratio, presence of septal shift, and pulmonary artery and aorta size were analysed in 504 positive CTPA scans and a representative cohort of 100 negative scans. Results were correlated using non-parametric analysis (two-tailed t-test or chi(2) test) and Pearson's rank correlation.

Results: Increasing thrombus load correlated with a higher RV: LV ratio, with a statistically significant difference in RV: LV ratios between the negative and positive pulmonary embolism (PE) cohorts. Larger thrombus loads (MMS >= 12 vs MMS = 12, as was an increase in pulmonary artery diameter (r=0.221, p

Conclusion: With increasing thrombus load in PE, there is CTPA evidence of RV decompensation with an MMS threshold of 12. This suggests a "tipping point" beyond which RV decompensation is more likely to occur. This is the first study to describe this tipping point between a thrombus load of MMS >12 and an increase in RV: LV ratio. This finding may help to improve risk stratification in patients with acute PE diagnosed by CTPA.

Original languageEnglish
Pages (from-to)1471-1476
Number of pages6
JournalBritish Journal of Radiology
Volume85
Issue number1019
DOIs
Publication statusPublished - Nov 2012

Keywords

  • Pulmonary Artery
  • Pulmonary Embolism
  • Lung
  • Humans
  • Ventricular Dysfunction, Right
  • Tomography, X-Ray Computed
  • Retrospective Studies
  • Middle Aged
  • Thrombosis

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