Prognostic value of right ventricular dysfunction and pulmonary obstruction index by computed tomographic pulmonary angiography in patients with acute pulmonary embolism.

OBJECTIVE To quantify right ventricular dysfunction (RVD) and pulmonary obstruction index assessed by computed tomographic pulmonary angiography (CTPA) to assess the predictive value of these CT parameters for mortality after the initial diagnosis of acute pulmonary embolism (APE). MATERIAL AND METHOD In 81 consecutive patients with proved APE, two readers assessed the extent of RVD, the shape of the interventricular septum, and the extent of obstruction to the pulmonary artery on CTPA images. The readers were blinded for clinical outcome in consensus reading. RESULTS During follow-up, 20 patients died (25%). CT signs of RVD (RV/LV ratio > 1.0) were seen in 47 patients (58%). The RV/LV ratio, the shape of interventricular septum, and the obstruction index were shown to be significant risk factors for mortality (p < 0.001, p = 0.04, p < 0.001, respectively). The negative predictive value for mortality with an RV/LV ratio < or = 1.0 and the obstruction index of < 40% were 100%. CONCLUSION CTPA quantification of RVD and pulmonary vascular obstruction index are potential useful tools to predict mortality in patients with APE.