Evaluation of right atrium-to-right ventricle diameter ratio on computed tomography pulmonary angiography: Prediction of adverse outcome and 30-day mortality

• Rapid risk stratification is required to plan an appropriate management in APE.
• CT is a valuable and quick method for risk stratification.
• Decreased cardiac output is an important predictive factor of adverse outcome.
• Cardiac morphological changes as predictive factors are easily measured on CT.

ObjectiveThe aim of this study was to examine the association between right atrium (RA) and right ventricle (RV) diameters on computed tomography (CT) pulmonary angiography in response to acute pulmonary embolism (APE), in addition to 30-day mortality and adverse outcomes in patients with APE.MethodsThis retrospective study was accepted by the institutional ethics committee. From January 2013 to March 2014, 79 hospitalized adult patients with symptomatic APE were included. Inclusion criteria were a CT pulmonary angiography positive for pulmonary embolism, availability of patient records, and a follow-up of at least 30 days. A review of patient records and images was performed. The maximum diameters of the heart chambers were measured on a reconstructed four-chamber heart view, and the vascular obstruction index was calculated on CT pulmonary angiography.ResultsThere were statistically significant relationships in both the RA/RV diameter ratio and the RV/left ventricle (LV) diameter ratio between patients with and without adverse outcomes (p < 0.001 and 0.002, respectively). Furthermore, there was a statistically significant difference in the RA/RV diameter ratio, but not in the RV/LV diameter ratio, between those with and without 30-day mortality (p = 0.002 and 0.148, respectively).ConclusionsMeasurement of the RA/RV diameter ratio may be an alternative and useful method for predicting 30-day mortality and adverse outcome in patients with APE.