Diagnostic and Prognostic Value of RV Strain Defined as RV/LV Ratio on Chest CT in Acute Pulmonary Embolism: A Systematic Review

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques Pub Date : 2025-03-03 DOI:10.1111/echo.70107

Ankit Hanmandlu, Aniruddh Mannari, Aiden Abidov

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引用次数: 0

Abstract

Background

Pulmonary embolism (PE) is a common cause of acute RV enlargement (often described as RV strain or RV-S), with significant associated mortality and morbidity. Chest CT pulmonary angiography is a widely available diagnostic modality to rule out PE and assess for RV-S, if positive for PE. Frequently, RV-S is assessed by measuring the right ventricular (RV) to left ventricular (LV) ratio (RV/LV ratio); however, there is no standardized technique for measuring CT RV/LV ratio, and the prognostic value of this marker is not well-defined.

Methods

PubMed and EMBASE databases were searched from inception to December 2023. A total of 35 studies were eligible for data collection based on relevance, completeness, and quality of data.

Results

The most common clinically effective cutoffs of the RV/LV ratio used were 0.9 and 1.0, and the most common methodology involved measuring RV and LV diameters within the same axial slice on both 2D (axial) and reconstructed 4-Chamber (4-Ch) views. Although 4-Ch and axial views had different RV/LV ratio predictability regarding specific outcomes such as 30-day death, there was no significant overall difference in the prognostic value across the different cutoffs used.

Conclusions

Our study demonstrates a lack of definite standardization in measuring CT RV/LV ratio in acute PE. Based on our review, we propose an RV strain defined as CT RV/LV ratio >1.0 measured on a single axial CT slice as an easily measurable and reliable marker of RV dysfunction in acute PE, with associated significant prognostic value in predicting adverse outcomes.

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以左心室/左心室比值定义的左心室毒株在急性肺栓塞中的诊断和预后价值：系统综述

肺栓塞（PE）是急性左心室扩大（常被描述为左心室毒株或RV- s）的常见原因，具有显著的相关死亡率和发病率。如果PE呈阳性，胸部CT肺血管造影是一种广泛使用的诊断方法，可用于排除PE和评估RV-S。通常，通过测量右心室（RV）与左心室（LV）的比值（RV/LV ratio）来评估RV- s；然而，没有标准化的技术来测量CT的RV/LV比值，该指标的预后价值也不明确。方法检索PubMed和EMBASE数据库，检索时间为建库至2023年12月。根据数据的相关性、完整性和质量，共有35项研究符合数据收集条件。结果临床上最常见的左室/左室比有效临界值分别为0.9和1.0，最常见的方法是在2D（轴向）和重建4室（4-Ch）视图上测量同一轴向切片内的左室和左室直径。虽然4-Ch视图和轴向视图对于特定结果（如30天死亡）具有不同的RV/LV比值可预测性，但在使用的不同截止点之间，预后价值没有显着的总体差异。结论：我们的研究表明，在测量急性肺动脉栓塞的CT RV/LV比值时缺乏明确的标准化。基于我们的综述，我们提出了一个定义为CT RV/LV比值>；1.0的左心室应变，在单轴CT片上测量，作为急性PE中容易测量和可靠的右心室功能障碍的标志，在预测不良结局方面具有重要的预后价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques 医学-心血管系统

CiteScore

2.40

自引率

6.70%

发文量

211

审稿时长

3-6 weeks

期刊介绍： Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques is the official publication of the International Society of Cardiovascular Ultrasound. Widely recognized for its comprehensive peer-reviewed articles, case studies, original research, and reviews by international authors. Echocardiography keeps its readership of echocardiographers, ultrasound specialists, and cardiologists well informed of the latest developments in the field.