Prognostic Value of CT-Derived Indicators of Right-Heart Strain and Thrombus Burden for In-Hospital Adverse Events in Acute Pulmonary Embolism

TL;DR

This study shows that CT scans can predict severe complications in patients with blood clots in the lungs by measuring heart strain and clot burden.

Contribution

The study demonstrates that CT-derived indicators of right-heart strain and thrombus burden are strong predictors of adverse events in acute pulmonary embolism.

Findings

Patients with adverse events had significantly higher RV/LV ratios, PAOI, and IVC contrast reflux compared to stable patients.

RV/LV ratio, PAOI, and IVC reflux were all independent predictors of adverse events with high statistical significance.

The predictive model achieved excellent discrimination with an AUC of 0.96.

Abstract

Background: Accurate risk stratification in acute pulmonary embolism (PE) is critical for guiding management. This study assessed the prognostic value of computed tomography (CT) indicators of right-heart strain and thrombus burden for predicting in-hospital adverse events. Methods: In this retrospective cohort of 300 patients with CT-confirmed acute PE, the right-to-left ventricular (RV/LV) diameter ratio, Pulmonary Artery Obstruction Index (PAOI), and inferior vena cava (IVC) contrast reflux were measured. The primary endpoint was in-hospital adverse events, including hemodynamic collapse, vasopressor or ventilatory support, rescue reperfusion therapy, or death. Logistic regression and receiver operating characteristic (ROC) analyses were performed. Results: Adverse events occurred in 106 patients (35.3%). Compared with stable patients, those with events had higher RV/LV ratios (1.45 vs. 1.03), higher PAOI (38.8 vs. 24.3), and more frequent IVC reflux (74% vs. 7%) (all p < 0.001). Independent predictors were RV/LV ratio (aOR 3.22 per 0.1), PAOI (aOR 5.53 per 10 points), and IVC reflux (aOR 428.5; all p < 0.001). The model showed excellent discrimination (AUC = 0.96). Conclusions: CT-derived indices of right-heart strain and thrombus burden are strong, independent predictors of in-hospital adverse events in acute PE and should be integrated into routine CT-based risk assessment.

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