Sex differences in the prognostic value of computed tomography pulmonary angiography parameters for intrahospital acute pulmonary embolism-related death

Background/Aim. Multidetector computed tomogr a- phy pulmonary angiography (MCTPA) has emerged as the most suitable method for diagnosing acute pulm o- nary embolism (APE) in hemodynamically stable p a- tients. In addition to its diagnostic role, MCTPA facil i- tates the measurement and calculation of certain parameters that can be used as prognostic markers for ou t- comes in APE. Since the introduction of the method, there have been a lot of studies that pointed out there may be a significant difference in the prognostic value of MCTPA for APE concerning sex. Methods. The study population consisted of consecutive patients with a diagnosis of APE confirmed by MCTPA. Positive MCTPA findings and a diagnosis of APE were esta b- lished if the patient had at least one segmental artery thrombus. APE severity was estimated using the simpli - fied Pulmonary Embolism Severity Index (sPESI). Allcause and APE - related intrahospital death s were the co primary outcomes of this study. Results. In total, 1,612 patients were enrolled in the study (750 men and 862 women). Women with a centrally positioned pulm o- nary thrombus detected on MCTPA were more likely to die from PE- related death than those without one (10.4% vs. 4.2%, respectively; p = 0.016). Women with a right ventricle (RV) and left ventricle (LV) diameter ratio (RV/LV) > 1 died almost twice as often as those with a ratio <= 1 (15.5% vs. 8.6%, respectively; p = 0.017). Women with an RV/LV > 1 detected with MCTPA were significantly more likely to die from PE than those with a ratio <= 1 (11% vs. 5.2%, respectively; p = 0.017). Women who died from PE- related causes had a significantly higher value of the embolic burden score system (EBSS) than did the surviving women (18.00 vs. 11.00, respectively; p = 0.025). Independently of age, sPESI, and renal function, the presence of a ce n- tral thrombus [odds ratio (OR) 2.278, 95% confidence interval (CI): 1.050 - 4.944, p = 0.037 ] and the RV/LV ratio > 1 (OR 2.015, 95% CI: 1.042 - 3.893, p = 0.037) were associated with intrahospital PE- related death in women. Conclusion. In women, MCTPA parameters, a centrally placed thrombus, the RV/LV ratio, and the EBSS had prognostic significance for PE- related mortality. The RV/LV ratio had prognostic significance for all- cause intrahospital mortality. In men, the MCTPA parameters had no prognostic significance for both overall and PErelated mortality.