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CT signs of right ventricular dysfunction: prognostic role in acute pulmonary embolism.

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dc.contributor.authorKang, DK-
dc.contributor.authorThilo, C-
dc.contributor.authorSchoepf, UJ-
dc.contributor.authorBarraza, JM Jr-
dc.contributor.authorNance, JW Jr-
dc.contributor.authorBastarrika, G-
dc.contributor.authorAbro, JA-
dc.contributor.authorRavenel, JG-
dc.contributor.authorCostello, P-
dc.contributor.authorGoldhaber, SZ-
dc.date.accessioned2012-05-02T04:45:25Z-
dc.date.available2012-05-02T04:45:25Z-
dc.date.issued2011-
dc.identifier.issn1936-878X-
dc.identifier.urihttp://repository.ajou.ac.kr/handle/201003/6678-
dc.description.abstractOBJECTIVES: The purpose of this study was to compare the prognostic role of various computed tomography (CT) signs of right ventricular (RV) dysfunction, including 3-dimensional ventricular volume measurements, to predict adverse outcomes in patients with acute pulmonary embolism (PE).



BACKGROUND: Three-dimensional ventricular volume measurements based on chest CT have become feasible for routine clinical application; however, their prognostic role in patients with acute PE has not been assessed.



METHODS: We evaluated 260 patients with acute PE for the following CT signs of RV dysfunction obtained on routine chest CT: abnormal position of the interventricular septum, inferior vena cava contrast reflux, right ventricle diameter (RVD) to left ventricle diameter (LVD) ratio on axial sections and 4-chamber (4-CH) views, and 3-dimensional right ventricle volume (RVV) to left ventricle volume (LVV) ratio. Comorbidities and fatal and nonfatal adverse outcomes according to the MAPPET-3 (Management Strategies and Prognosis in Pulmonary Embolism Trial-3) criteria within 30 days were recorded.



RESULTS: Fifty-seven patients (21.9%) had adverse outcomes, including 20 patients (7.7%) who died within 30 days. An RVD(axial)/LVD(axial) ratio >1.0 was not predictive for adverse outcomes. On multivariate analysis (adjusting for comorbidities), abnormal position of the interventricular septum (hazard ratio [HR]: 2.07; p = 0.007), inferior vena cava contrast reflux (HR: 2.57; p = 0.001), RVD(4-CH)/LVD(4-CH) ratio >1.0 (HR: 2.51; p = 0.009), and RVV/LVV ratio >1.2 (HR: 4.04; p < 0.001) were predictive of adverse outcomes, whereas RVD(4-CH)/LVD(4-CH) ratio >1.0 (HR: 3.68; p = 0.039) and RVV/LVV ratio >1.2 (HR: 6.49; p = 0.005) were predictive of 30-day death.



CONCLUSIONS: Three-dimensional ventricular volume measurement on chest CT is a predictor of early death in patients with acute PE, independent of clinical risk factors and comorbidities. Abnormal position of the interventricular septum, inferior vena cava contrast reflux, and RVD(4-CH)/LVD(4-CH) ratio are predictive of adverse outcomes, whereas RVD(axial)/LVD(axial) ratio >1.0 is not.
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dc.language.isoen-
dc.subject.MESHAcute Disease-
dc.subject.MESHAdult-
dc.subject.MESHAged-
dc.subject.MESHChi-Square Distribution-
dc.subject.MESHFemale-
dc.subject.MESHHumans-
dc.subject.MESHImaging, Three-Dimensional-
dc.subject.MESHMale-
dc.subject.MESHMiddle Aged-
dc.subject.MESHMultivariate Analysis-
dc.subject.MESHObserver Variation-
dc.subject.MESHPredictive Value of Tests-
dc.subject.MESHPrognosis-
dc.subject.MESHProportional Hazards Models-
dc.subject.MESHPulmonary Embolism-
dc.subject.MESHRadiographic Image Interpretation, Computer-Assisted-
dc.subject.MESHReproducibility of Results-
dc.subject.MESHRetrospective Studies-
dc.subject.MESHRisk Assessment-
dc.subject.MESHRisk Factors-
dc.subject.MESHTime Factors-
dc.subject.MESHTomography, X-Ray Computed-
dc.subject.MESHVentricular Dysfunction, Right-
dc.subject.MESHVentricular Function, Right-
dc.titleCT signs of right ventricular dysfunction: prognostic role in acute pulmonary embolism.-
dc.typeArticle-
dc.identifier.pmid21835376-
dc.identifier.urlhttp://linkinghub.elsevier.com/retrieve/pii/S1936-878X(11)00385-8-
dc.contributor.affiliatedAuthor강, 두경-
dc.type.localJournal Papers-
dc.identifier.doi10.1016/j.jcmg.2011.04.013-
dc.citation.titleJACC. Cardiovascular imaging-
dc.citation.volume4-
dc.citation.number8-
dc.citation.date2011-
dc.citation.startPage841-
dc.citation.endPage849-
dc.identifier.bibliographicCitationJACC. Cardiovascular imaging, 4(8). : 841-849, 2011-
dc.identifier.eissn1876-7591-
dc.relation.journalidJ01936878X-
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Journal Papers > School of Medicine / Graduate School of Medicine > Radiology
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