Risk assessment of acute pulmonary embolism utilizing coronary artery calcifications in patients that have undergone CT pulmonary angiography and transthoracic echocardiography.
Computed tomography angiography
Coronary artery disease
Pulmonary embolism
Journal
European radiology
ISSN: 1432-1084
Titre abrégé: Eur Radiol
Pays: Germany
ID NLM: 9114774
Informations de publication
Date de publication:
May 2021
May 2021
Historique:
received:
11
06
2020
accepted:
06
10
2020
revised:
18
08
2020
pubmed:
15
10
2020
medline:
16
4
2021
entrez:
14
10
2020
Statut:
ppublish
Résumé
To evaluate the relation of coronary artery calcifications (CAC) on non-ECG-gated CT pulmonary angiography (CTPA) with short-term mortality in patients with acute pulmonary embolism (PE). We retrospectively included all in-patients between May 2007 and December 2014 with an ICD-9 code for acute PE and CTPA and transthoracic echocardiography available. CAC was qualitatively graded as absent, mild, moderate, or severe. Relations of CAC with overall and PE-related 30-day mortality were assessed using logistic regression analyses. The independence of those relations was assessed using a nested approach, first adjusting for age and gender, then for RV strain, peak troponin T, and cardiovascular risk factors for an overall model. Four hundred seventy-nine patients were included (63 ± 16 years, 52.8% women, 47.2% men). In total, 253 (52.8%) had CAC-mild: 143 (29.9%); moderate: 89 (18.6%); severe: 21 (4.4%). Overall mortality was 8.8% (n = 42) with higher mortality with any CAC (12.6% vs. 4.4% without; odds ratio [OR] 3.1 [95%CI 2.1-14.5]; p = 0.002). Mortality with severe (19.0%; OR 5.1 [95%CI 1.4-17.9]; p = 0.011), moderate (11.2%; OR 2.7 [95%CI 1.1-6.8]; p = 0.031), and mild CAC (12.6%; OR 3.1 [95%CI 1.4-6.9]; p = 0.006) was higher than without. OR adjusted for age and gender was 2.7 (95%CI 1.0-7.1; p = 0.050) and 2.6 (95%CI 0.9-7.1; p = 0.069) for the overall model. PE-related mortality was 4.0% (n = 19) with higher mortality with any CAC (5.9% vs. 1.8% without; OR 3.5 [95%CI 1.1-10.7]; p = 0.028). PE-related mortality with severe CAC was 9.5% (OR 5.8 [95%CI 1.0-34.0]; p = 0.049), with moderate CAC 6.7% (OR 4.0 [95%CI 1.1-14.6]; p = 0.033), and with mild 4.9% (OR 2.9 [95%CI 0.8-9.9]; p = 0.099). OR adjusted for age and gender was 4.2 (95%CI 0.9-20.7; p = 0.074) and 3.4 (95%CI 0.7-17.4; p = 0.141) for the overall model. Patients with sub-massive PE showed similar results. CAC is frequent in acute PE patients and associated with short-term mortality. Visual assessment of CAC may serve as an easy, readily available tool for early risk stratification in those patients. • Coronary artery calcification assessed on computed tomography pulmonary angiography is frequent in patients with acute pulmonary embolism. • Coronary artery calcification assessed on computed tomography pulmonary angiography is associated with 30-day overall and PE-related mortality in patients with acute pulmonary embolism. • Coronary artery calcification assessed on computed tomography pulmonary angiography may serve as an additional, easy readily available tool for early risk stratification in those patients.
Identifiants
pubmed: 33051734
doi: 10.1007/s00330-020-07385-5
pii: 10.1007/s00330-020-07385-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2809-2818Commentaires et corrections
Type : ErratumIn
Références
Konstantinides SV, Meyer G, Becattini C et al (2019) 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J. 2019 Oct 9;54(3):1901647. https://doi.org/10.1183/13993003.01647-2019
Lualdi JC, Goldhaber SZ (1995) Right ventricular dysfunction after acute pulmonary embolism: pathophysiologic factors, detection, and therapeutic implications. Am Heart J 130:1276–1282
doi: 10.1016/0002-8703(95)90155-8
Matthews JC, McLaughlin V (2008) Acute right ventricular failure in the setting of acute pulmonary embolism or chronic pulmonary hypertension: a detailed review of the pathophysiology, diagnosis, and management. Curr Cardiol Rev 4:49–59
doi: 10.2174/157340308783565384
Parast L, Cai B, Bedayat A et al (2012) Statistical methods for predicting mortality in patients diagnosed with acute pulmonary embolism. Acad Radiol 19:1465–1473
doi: 10.1016/j.acra.2012.09.008
Zuin M, Rigatelli G, Faggian G, Zonzin P, Roncon L (2016) Short-term outcome of patients with history of significant coronary artery disease following acute pulmonary embolism. Eur J Intern Med 34:e16–e17
doi: 10.1016/j.ejim.2016.05.015
Hecht HS, Cronin P, Blaha MJ et al (2017) 2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology. J Cardiovasc Comput Tomogr 11:74–84
doi: 10.1016/j.jcct.2016.11.003
Budoff MJ, Young R, Lopez VA et al (2013) Progression of coronary calcium and incident coronary heart disease events: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol 61:1231–1239
doi: 10.1016/j.jacc.2012.12.035
Williams MC, Morley NCD, Muir KC, Reid JH, van Beek EJR, Murchison JT (2019) Coronary artery calcification is associated with mortality independent of pulmonary embolism severity: a retrospective cohort study. Clin Radiol 74:973.e7-973.e14.
Jaff MR, McMurtry MS, Archer SL et al (2011) Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation 123:1788–1830
doi: 10.1161/CIR.0b013e318214914f
Carroll BJ, Heidinger BH, Dabreo DC et al (2018) Multimodality Assessment of Right Ventricular Strain in Patients With Acute Pulmonary Embolism. Am J Cardiol 122:175–181
doi: 10.1016/j.amjcard.2018.03.013
Mohebali D, Heidinger BH, Feldman SA et al (2020) Right ventricular strain in patients with pulmonary embolism and syncope. J Thromb Thrombolysis 50:157–164
doi: 10.1007/s11239-019-01976-w
Matos JD, Balachandran I, Heidinger BH et al (2020) Mitral annular plane systolic excursion and tricuspid annular plane systolic excursion for risk stratification of acute pulmonary embolism. Echocardiography 37:1008–1013
doi: 10.1111/echo.14761
Chiles C, Duan F, Gladish GW et al (2015) Association of coronary artery calcification and mortality in the national lung screening trial: a comparison of three scoring methods. Radiology 276:82–90
doi: 10.1148/radiol.15142062
Shemesh J, Henschke CI, Shaham D et al (2010) Ordinal scoring of coronary artery calcifications on low-dose CT scans of the chest is predictive of death from cardiovascular disease. Radiology 257:541–548
doi: 10.1148/radiol.10100383
Dirrichs T, Penzkofer T, Reinartz SD, Kraus T, Mahnken AH, Kuhl CK (2015) Extracoronary thoracic and coronary artery calcifications on chest ct for lung cancer screening: association with established cardiovascular risk factors - the "CT-Risk" trial. Acad Radiol 22:880–889
doi: 10.1016/j.acra.2015.03.005
Kiryu S, Raptopoulos V, Baptista J, Hatabu H (2003) Increased prevalence of coronary artery calcification in patients with suspected pulmonary embolism. Acad Radiol 10:840–845
doi: 10.1016/S1076-6332(03)00013-8
Johnson C, Khalilzadeh O, Novelline RA, Choy G (2014) Coronary artery calcification is often not reported in pulmonary CT angiography in patients with suspected pulmonary embolism: an opportunity to improve diagnosis of acute coronary syndrome. AJR Am J Roentgenol 202:725–729
doi: 10.2214/AJR.13.11326
van der Bijl N, Klok FA, Huisman MV, de Roos A, Kroft LJ (2016) Coronary or thoracic artery calcium score in provoked and unprovoked pulmonary embolism: a case-control study. J Thromb Haemost 14:931–935
doi: 10.1111/jth.13289
Hong C, Zhu F, Du D, Pilgram TK, Sicard GA, Bae KT (2005) Coronary artery calcification and risk factors for atherosclerosis in patients with venous thromboembolism. Atherosclerosis 183:169–174
doi: 10.1016/j.atherosclerosis.2005.03.047
Gondrie MJ, Mali WP, Jacobs PC, Oen AL, van der Graaf Y (2010) Cardiovascular disease: prediction with ancillary aortic findings on chest CT scans in routine practice. Radiology 257:549–559
doi: 10.1148/radiol.10100054
Gondrie MJ, van der Graaf Y, Jacobs PC, Oen AL, Mali WP (2011) The association of incidentally detected heart valve calcification with future cardiovascular events. Eur Radiol 21:963–973
doi: 10.1007/s00330-010-1995-0
Lu MT, Demehri S, Cai T et al (2012) Axial and reformatted four-chamber right ventricle-to-left ventricle diameter ratios on pulmonary CT angiography as predictors of death after acute pulmonary embolism. AJR Am J Roentgenol 198:1353–1360
doi: 10.2214/AJR.11.7439
Pruszczyk P, Goliszek S, Lichodziejewska B et al (2014) Prognostic value of echocardiography in normotensive patients with acute pulmonary embolism. JACC Cardiovasc Imaging 7:553–560
doi: 10.1016/j.jcmg.2013.11.004
Fernandez C, Bova C, Sanchez O et al (2015) Validation of a model for identification of patients at intermediate to high risk for complications associated with acute symptomatic pulmonary embolism. Chest 148:211–218
doi: 10.1378/chest.14-2551
Yamashita Y, Morimoto T, Amano H et al (2020) Usefulness of simplified pulmonary embolism severity index score for identification of patients with low-risk pulmonary embolism and active cancer: from the COMMAND VTE registry. Chest 157:636–644
doi: 10.1016/j.chest.2019.08.2206
Barrios D, Rosa-Salazar V, Jimenez D et al (2016) Right heart thrombi in pulmonary embolism. Eur Respir J 48:1377–1385
doi: 10.1183/13993003.01044-2016
Kang DK, Thilo C, Schoepf UJ et al (2011) CT signs of right ventricular dysfunction: prognostic role in acute pulmonary embolism. JACC Cardiovasc Imaging 4:841–849
doi: 10.1016/j.jcmg.2011.04.013
Bach AG, Nansalmaa B, Kranz J et al (2015) CT pulmonary angiography findings that predict 30-day mortality in patients with acute pulmonary embolism. Eur J Radiol 84:332–337
doi: 10.1016/j.ejrad.2014.11.023
Aviram G, Soikher E, Bendet A et al (2016) Prediction of mortality in pulmonary embolism based on left atrial volume measured on CT pulmonary angiography. Chest 149:667–675
doi: 10.1378/chest.15-0666
Meinel FG, Nance JW Jr, Schoepf UJ et al (2015) Predictive value of computed tomography in acute pulmonary embolism: systematic review and meta-analysis. Am J Med 128:747–759 e742
doi: 10.1016/j.amjmed.2015.01.023
Aviram G, Rogowski O, Gotler Y et al (2008) Real-time risk stratification of patients with acute pulmonary embolism by grading the reflux of contrast into the inferior vena cava on computerized tomographic pulmonary angiography. J Thromb Haemost 6:1488–1493
doi: 10.1111/j.1538-7836.2008.03079.x
Sverzellati N, Arcadi T, Salvolini L et al (2016) Under-reporting of cardiovascular findings on chest CT. Radiol Med 121:190–199
doi: 10.1007/s11547-015-0595-0
Munden RF, Carter BW, Chiles C et al (2018) Managing incidental findings on thoracic CT: mediastinal and cardiovascular findings. A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 15:1087–1096
doi: 10.1016/j.jacr.2018.04.029
Aujesky D, Obrosky DS, Stone RA et al (2005) Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med 172:1041–1046
doi: 10.1164/rccm.200506-862OC