Objectives: We used retrospectively ECG synchronized cardiopulmonary computed tomographic angiography (CPCT) for the evaluation of pulmonary arterial thromboembolism (PATE) and aimed at defining the value of this technique in comprehensive anatomic and functional evaluation of cardiopulmonary system in the setting of this severe cardiovascular emergency.
Methods: Study population comprised of 75 consecutive patients with suspected acute PATE referred for CPCT. Acute PATE was diagnosed in 30 patients (PATE group) and in 45 patients it was ruled out (control group). Right and left ventricular functional parameters were compared between groups and associations with pulmonary arterial thromboembolic burden were defined. Quality of CPCT images for the analysis of the coronary arteries was evaluated using 4 point rating scale in four major coronary arteries - left main, left anterior descending, left circumflex and right coronary artery.
Results: There were statistically significant differences of the right and left ventricular morphometric and functional parameters between PATE and control group. Multiple linear regression analysis showed that pulmonary artery clot load and left ventricular ejection fraction are significant predictors of reduced right ventricular ejection fraction (beta coefficients -0.516, p < 0.05 and 0.490, p < 0.05 respectively). The most accurate predictor of markedly reduced right ventricular ejection fraction was right and left ventricular end-diastolic volumes ratio (area under the curve 0.933, p < 0.005). Reliable exclusion of significant coronary artery disease was possible in 38 (84.4%) patients of control group and 3 (10%) patients of PATE group.
Conclusions: In patients with acute PATE, right ventricular dysfunction is accompanied by detectable changes of the left ventricle. Most accurate predictors of markedly reduced right ventricular ejection fraction are right and left ventricular end-diastolic volumes ratio and right and left ventricular diameters ratio. Quality of CPCT images is sufficient for the evaluation of coronary arteries and thoracic aorta allowing exclusion of significant coronary artery disease and dissection of thoracic aorta.
