Relationship Between Shock Index, sPESI Score, and Right Ventricular Dysfunction in CTPA with Mortality in Patients Diagnosed with Acute PTE in the Emergency Department

Abstract

. ABSTRACT Objective: Pulmonary thromboembolism (PTE) is a cardiovascular disease that occurs as a result of occlusion of the main pulmonary artery and/or its branches due to thrombus or another reason, requiring urgent diagnosis and treatment. Several scoring systems are used to predict mortality due to PTE. In our study, we aimed to show the superiority of the right ventricular/left ventricular (RV/LV) ratio in predicting 30-day mortality using simplified pulmonary embolism severity index (sPESI), shock index (SI), and computed tomography pulmonary angiography (CTPA). Methods: This was a retrospective, cross-sectional study. The study was conducted on patients diagnosed with acute PTE who were admitted to the Emergency Department of University of Health Sciences Turkey, Şişli Hamidiye Etfal Training and Research Hospital between January 01, 2017 and November 17, 2021. Demographic characteristics, clinical features, and vital parameters of the patients were recorded. SI, sPESI score, and RV/LV ratio were calculated. SI ≥1.0, sPESI ≥1.0, and RV/LV ≥1.0 were considered high risk. Results: A total of 205 patients, of which 55.6% were female, were included in the study. The mean age of the patients in our study was 67.1±16.6 (minimum-maximum =20.0-105.0). We found statistically significant differences in sPESI, SI, and RV/LV ratio between the mortality and survival groups (p<0.05). In our study, we accepted PESI [area under the curve (AUC) =0.776] as the gold standard and performed receiver operating characteristic curve analysis to determine mortality in sPESI (AUC =0.697), SI (AUC =0.654), and RV/LV ratio (AUC =0.605). We found that the sPESI, SI, and RV/LV ratios were moderately predictive and statistically significant, respectively (p<0.001, p<0.001, p=0.001, p=0.0028). Conclusion: We believe that CTPA can be used as a single procedure for diagnosis and risk stratification in patients with acute PTE. SI, sPESI, and RV/ LV ratios were found to be significant in predicting 30-day mortality.