Assessing the severity of pulmonary embolism among patients in the emergency department: Utility of RV/LV diameter ratio.
<h4>Background</h4>Acute pulmonary embolism (APE) is a major cause of death from cardiovascular disease. Right ventricular systolic dysfunction (RVD) caused by APE is closely related to a poor outcome. Early risk stratification of APE is a vital step in prognostic assessment. The objecti...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2020-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0242340 |
| _version_ | 1819110743560159232 |
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| author | Sung-Uk Cho Young-Duck Cho Sung-Hyuk Choi Young-Hoon Yoon Jong-Hak Park Sung-Joon Park Eu-Sun Lee |
| author_facet | Sung-Uk Cho Young-Duck Cho Sung-Hyuk Choi Young-Hoon Yoon Jong-Hak Park Sung-Joon Park Eu-Sun Lee |
| author_sort | Sung-Uk Cho |
| collection | DOAJ |
| description | <h4>Background</h4>Acute pulmonary embolism (APE) is a major cause of death from cardiovascular disease. Right ventricular systolic dysfunction (RVD) caused by APE is closely related to a poor outcome. Early risk stratification of APE is a vital step in prognostic assessment. The objective of this study was to investigate the usefulness of computed tomographic pulmonary angiography (CTPA) measured right ventricular (RV)/ left ventricular (LV) diameter ratio by the emergency department (ED) specialists for early risk stratification of APE patients in ED.<h4>Methods</h4>The retrospective data of 229 APE patients were reviewed. Two ED specialists measured both RV and LV diameters on a single transverse scan perpendicular to the long axis of the heart. The patients were divided into two groups, RV/LV diameter ratio <1 and ratio >1. CTPA measured RV/LV diameter ratio were analyzed and compared with sPESI score, cardiac biomarkers such as N-Terminal Pro-B-Type Natriuretic Peptide (NT-pro-BNP), high sensitivity cardiac troponin T (hs-cTnT), and RVD measured by echocardiography (Echo).<h4>Results</h4>The mean age in RV/LV > 1 group was significantly higher than that of the other group (67.81±2.7 years vs. 60.68±3.2 years). Also, there were more hypertension patients (44.4% vs. 33.3%), and mean arterial pressure (MAP) was lower. A significantly higher ICU admission rate (28.05% vs. 11.61%) was shown in RV/LV >1 group, and five patients expired only in RV/LV > 1 group. RVD by Echo demonstrated the highest sensitivity, specificity, and negative predictive value (NPV) (values of 94.3%, 81.1%, 95.5%). RV/LV >1 diameter ratio by CTPA showed usefulness equivalent to cardiac biomarkers. RV/LV >1 patients' cardiac enzymes were higher, and there were more RVD in RV/LV >1 group.<h4>Conclusion</h4>Simple measurement of RV/LV diameter ratio by ED specialist would be a help to the clinicians in identifying and stratifying the risk of the APE patients presenting in the ED. |
| first_indexed | 2024-12-22T03:46:34Z |
| format | Article |
| id | doaj.art-9f637c0ae978460899156d179e0ae4b2 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-22T03:46:34Z |
| publishDate | 2020-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj.art-9f637c0ae978460899156d179e0ae4b22022-12-21T18:40:07ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-011511e024234010.1371/journal.pone.0242340Assessing the severity of pulmonary embolism among patients in the emergency department: Utility of RV/LV diameter ratio.Sung-Uk ChoYoung-Duck ChoSung-Hyuk ChoiYoung-Hoon YoonJong-Hak ParkSung-Joon ParkEu-Sun Lee<h4>Background</h4>Acute pulmonary embolism (APE) is a major cause of death from cardiovascular disease. Right ventricular systolic dysfunction (RVD) caused by APE is closely related to a poor outcome. Early risk stratification of APE is a vital step in prognostic assessment. The objective of this study was to investigate the usefulness of computed tomographic pulmonary angiography (CTPA) measured right ventricular (RV)/ left ventricular (LV) diameter ratio by the emergency department (ED) specialists for early risk stratification of APE patients in ED.<h4>Methods</h4>The retrospective data of 229 APE patients were reviewed. Two ED specialists measured both RV and LV diameters on a single transverse scan perpendicular to the long axis of the heart. The patients were divided into two groups, RV/LV diameter ratio <1 and ratio >1. CTPA measured RV/LV diameter ratio were analyzed and compared with sPESI score, cardiac biomarkers such as N-Terminal Pro-B-Type Natriuretic Peptide (NT-pro-BNP), high sensitivity cardiac troponin T (hs-cTnT), and RVD measured by echocardiography (Echo).<h4>Results</h4>The mean age in RV/LV > 1 group was significantly higher than that of the other group (67.81±2.7 years vs. 60.68±3.2 years). Also, there were more hypertension patients (44.4% vs. 33.3%), and mean arterial pressure (MAP) was lower. A significantly higher ICU admission rate (28.05% vs. 11.61%) was shown in RV/LV >1 group, and five patients expired only in RV/LV > 1 group. RVD by Echo demonstrated the highest sensitivity, specificity, and negative predictive value (NPV) (values of 94.3%, 81.1%, 95.5%). RV/LV >1 diameter ratio by CTPA showed usefulness equivalent to cardiac biomarkers. RV/LV >1 patients' cardiac enzymes were higher, and there were more RVD in RV/LV >1 group.<h4>Conclusion</h4>Simple measurement of RV/LV diameter ratio by ED specialist would be a help to the clinicians in identifying and stratifying the risk of the APE patients presenting in the ED.https://doi.org/10.1371/journal.pone.0242340 |
| spellingShingle | Sung-Uk Cho Young-Duck Cho Sung-Hyuk Choi Young-Hoon Yoon Jong-Hak Park Sung-Joon Park Eu-Sun Lee Assessing the severity of pulmonary embolism among patients in the emergency department: Utility of RV/LV diameter ratio. PLoS ONE |
| title | Assessing the severity of pulmonary embolism among patients in the emergency department: Utility of RV/LV diameter ratio. |
| title_full | Assessing the severity of pulmonary embolism among patients in the emergency department: Utility of RV/LV diameter ratio. |
| title_fullStr | Assessing the severity of pulmonary embolism among patients in the emergency department: Utility of RV/LV diameter ratio. |
| title_full_unstemmed | Assessing the severity of pulmonary embolism among patients in the emergency department: Utility of RV/LV diameter ratio. |
| title_short | Assessing the severity of pulmonary embolism among patients in the emergency department: Utility of RV/LV diameter ratio. |
| title_sort | assessing the severity of pulmonary embolism among patients in the emergency department utility of rv lv diameter ratio |
| url | https://doi.org/10.1371/journal.pone.0242340 |
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