# 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.

## Key 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.