Benefit of combining quantitative cardiac CT parameters with troponin I for predicting right ventricular dysfunction and adverse clinical events in patients with acute pulmonary embolism

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• 作者：Mathias Meyer ; Christian Fink ; Susanne Roeger ; Paul Apfaltrer ; Dariush Haghi ; Wolfgang E. Kaminski ; Michael Neumaier ; Stefan O. Schoenberg ; Thomas Henzler
• 关键词：Pulmonary embolism ; Right ventricular dysfunction ; Computed tomography ; Adverse outcome ; Troponin I
• 刊名：European Journal of Radiology
• 出版年：2012
• 出版时间：November, 2012
• 年：2012
• 卷：81
• 期：11
• 页码：3294-3299
• 全文大小：564 K

文摘

Objective

To prospectively evaluate the diagnostic accuracy of quantitative cardiac CT parameters alone and in combination with troponin I for the assessment of right ventricular dysfunction (RVD) and adverse clinical events in patients with acute pulmonary embolism (PE).

Materials and results

This prospective study had institutional review board approval and was HIPAA compliant. In total 83 patients with confirmed PE underwent echocardiography and troponin I serum level measurements within 24 h. Three established cardiac CT measurements for the assessment of RVD were obtained (RV/LV_axial, RV/LV_4-CH, and RV/LV_volume). CT measurements and troponin I serum levels were correlated with RVD found on echocardiography and adverse clinical events according to Management Strategies and Prognosis in Pulmonary Embolism Trial-3 (MAPPET-3 criteria. 31 of 83 patients with PE had RVD on echocardiography and 39 of 83 patients had adverse clinical events. A RV/LV_volume ratio > 1.43 showed the highest area under the curve (AUC) (0.65) for the prediction of adverse clinical events when compared to RV/LV_axial, RV/LV_4Ch and troponin I. The AUC for the detection of RVD of RV/LV_axial, RV/LV_4Ch, RV/LV_volume, and troponin I were 0.86, 0.86, 0.92, and 0.69, respectively. Combination of RV/LV_axial, RV/LV_4Ch, RV/LV_volume with troponin I increased the AUC to 0.87, 0.87 and 0.93, respectively.

Conclusion

A combination of cardiac CT parameters and troponin I measurements improves the diagnostic accuracy for detecting RVD and predicting adverse clinical events if compared to either test alone.