Relationship between clot burden in pulmonary computed tomography angiography and different parameters of right cardiac dysfunction in acute pulmonary embolism

Background: Pulmonary computed tomography angiography (CTA) contains a wealth of information regarding the diagnosis and impact of acute pulmonary embolism (PE). Echocardiography remains the recommended examination to detect signs of right ventricular (RV) dysfunction in patients with shock or hypotension following PE. Objectives: To detect the relationship between clot volume in pulmonary CTA and different parameters of RV dysfunction assessed by echocardiography and pulmonary CTA in patients with acute PE. Methods: A cross-sectional study was performed on patients with acute PE from June 2017 to June 2018. Enrolled patients were assessed clinically, radiologically and for cardiac dysfunction. The relationship between clot volume and RV dysfunction was assessed using pulmonary CTA and echocardiography. Data were analysed with SPSS version 16. Correlations were studied using the Spearman and Kruskal Wallis tests. Results: There was a significant correlation found between clot volume and parameters of RV dysfunction, assessed by pulmonary CTA, including RV diameter (p < 0.001), RV to left ventricular (LV) diameter ratio (p = 0.01), pulmonary artery diameter (p = 0.01), ratio of main pulmonary artery to ascending aorta diameter (p = 0.04), and superior vena cava diameter (p = 0.01). On the other hand, there was no significant correlation between clot volume and parameters of RV dysfunction assessed by echocardiography. Conclusion: In patients with acute PE, the assessment of RV dysfunction using pulmonary CTA showed good correlation with clot burden, unlike the assessment done with echocardiography.