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(Circulation. 2004;109:2401-2404.)
© 2004 American Heart Association, Inc.

Brief Rapid Communications

Right Ventricular Enlargement on Chest Computed Tomography

Prognostic Role in Acute Pulmonary Embolism

Rene Quiroz, MD, MPH^*; Nils Kucher, MD^*; U. Joseph Schoepf, MD; Florian Kipfmueller, BS; Scott D. Solomon, MD; Philip Costello, MD; Samuel Z. Goldhaber, MD

From the Cardiovascular Division (N.K., S.D.S., S.Z.G.) and the Department of Radiology (R.Q., U.J.S., F.K., P.C.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.

Correspondence to Samuel Z. Goldhaber, MD, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail sgoldhaber{at}partners.org

Received February 26, 2004; revision received April 6, 2004; accepted April 7, 2004.

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 (RV_D, LV_D) with axial and 2-dimensional reconstructed 4-chamber (4-CH) views. The proportion of patients with RV_D/LV_D>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, RV_D/LV_D>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 RV_D/LV_D from the axial and 4-CH views for predicting adverse events was 0.667 and 0.753, respectively. Sensitivity and specificity of RV_D/LV_D>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. RV_D/LV_D>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.

Key Words: tomography • embolism • prognosis • thrombosis

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