This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Kipfmueller, F. Articles by Kucher, N. Search for Related Content PubMed PubMed Citation Articles by Kipfmueller, F. Articles by Kucher, N. Social Bookmarking                         What's this?

Chest CT assessment following thrombolysis or surgical embolectomy for acute pulmonary embolism

Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

Rene Quiroz

Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

Samuel Z Goldhaber

Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

U Joseph Schoepf

Department of Radiology, Medical University of South Carolina, Charleston, SC, USA

Philip Costello

Department of Radiology, Medical University of South Carolina, Charleston, SC, USA

Nils Kucher

Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA, nkucher{at}partners.org

Right ventricular (RV) enlargement, assessed by two-dimensional reconstructed 4-chamber views on contrast-enhanced multirow detector computed tomography (MDCT), is emerging as an important marker for predicting adverse clinical events in patients with acute pulmonary embolism (PE). It is unclear whether dynamic changes occur on chest computed tomography (CT) in response to thrombolysis or embolectomy to treat acute PE. We retrospectively investigated 23 consecutive patients who met the criteria of (1) a positive MDCT PE protocol; (2) RV dysfunction on echocardiography; (3) reperfusion therapy by systemic thrombolysis (n = 17) or surgical embolectomy (n = 6); and (4) follow-up MDCT study after completion of therapy. Two blinded observers reconstructed 4-chamber views on a Leonardo^TM (Siemens, Munich, Germany) workstation using multiplanar reformats of axial CT data and then measured right and left ventricular dimensions (RV_D, LV_D). RV enlargement was defined as RV_D/LV_D 0.9. Mean age was 52 years, and there were 10 (43%) women. The median time to MDCT follow-up was 21 (range 2-231) days. Seventeen (74%) patients had their chest MDCT follow-up within 30 days. All 23 patients had RV enlargement (mean RV_D/LV_D 1.28, range 0.94 to 1.74) prior to initiation of reperfusion therapy. Although right ventricular enlargement was found in 43% of patients at follow-up, the mean RV_D/LV_D decreased from 1.28 ± 0.21 cm to 0.94 ± 0.16 cm (p = 0.001). The mean change in RV_D/LV_D was 0.31 ± 0.42 in thrombolysis patients and 0.42 ± 0.09 in embolectomy patients (p = 0.33). Reconstructed 4-chamber views on chest CT provide noninvasive imaging of right ventricular enlargement and permit dynamic assessment of the right ventricular response to thrombolysis and embolectomy in patients with acute PE.

Key Words: computed tomography • echocardiography • prognosis • pulmonary embolism • right ventricular dysfunction

Vascular Medicine, Vol. 10, No. 2, 85-89 (2005)
DOI: 10.1191/1358863x05vm610oa


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				M. T. Lu, T. Cai, H. Ersoy, A. G. Whitmore, R. Quiroz, S. Z. Goldhaber, and F. J. Rybicki Interval Increase in Right-Left Ventricular Diameter Ratios at CT as a Predictor of 30-day Mortality after Acute Pulmonary Embolism: Initial Experience Radiology, January 1, 2008; 246(1): 281 - 287. [Abstract] [Full Text] [PDF]

				V. Palmieri, E. A. Palmieri, and A. Celentano Functional limitation and right ventricular dysfunction at 6-month follow-up in patients with non-massive pulmonary embolism: useful outcomes for testing therapy of acute submassive pulmonary embolism? Eur. Heart J., October 2, 2007; 28(20): 2430 - 2431. [Full Text] [PDF]

				D. J. Carlbom and B. L. Davidson Pulmonary Embolism in the Critically Ill Chest, July 1, 2007; 132(1): 313 - 324. [Abstract] [Full Text] [PDF]