Right ventricular enlargement on chest computed tomography - Prognostic role in acute pulmonary embolism

Background - We investigated the prognostic role of right ventricular enlargement on multidetector-row chest CT in acute pulmonary embolism ( PE). Methods and Results - We studied 63 patients with CT-confirmed PE who underwent echocardiography within the ensuing 24 hours. Adverse clinical events, defined as 30-day mortality or the need for cardiopulmonary resuscitation, mechanical ventilation, pressors, rescue thrombolysis, or surgical embolectomy, were present in 24 patients. We performed off-line CT measurements of right and left ventricular dimensions (RVD, LVD) with axial and 2-dimensional reconstructed 4-chamber (4-CH) views. The proportion of patients with RVD/LVD > 0.9 on the axial view was similar in patients with (70.8%) and those without adverse events (71.8%; P = 0.577). In contrast, RVD/LVD > 0.9 on the 4-CH view was more common in patients with (80.3%) than without (51.3%; P = 0.015) adverse events. The area under the curve of RVD/LVD from the axial and 4-CH views for predicting adverse events was 0.667 and 0.753, respectively. Sensitivity and specificity of RVD/LVD > 0.9 for predicting adverse events were 37.5% and 92.3% on the axial view and 83.3% and 48.7% on the reconstructed 4-CH view, respectively. RVD/LVD > 0.9 on the 4-CH view was an independent predictor for adverse events (OR, 4.02; 95% CI, 1.06 to 15.19; P = 0.041) when adjusted for age, obesity, cancer, and recent surgery. Conclusions - Right ventricular enlargement on the reconstructed CT 4-CH views predicts adverse clinical events in patients with acute PE. Ventricular CT measurements obtained from 4-CH views are superior to those from axial views for identifying high-risk patients.