Novel method for pulmonary embolism prognosis: Right to left ventricular volume ratio (RLVR) on pulmonary angiography (CTPA)

Abstract

Introduction

Right ventricular dysfunction is the main cause of mortality in patients with acute massive pulmonary embolism (PE) and early diagnosis is extremely important. This study aimed to investigate whether the right/left ventricular volume ratio (RLVR) calculated using pulmonary angiography (CTPA) is a valuable tool for PE prognosis.

Method

Clinical, echocardiographic and pulmonary angiography data of cases diagnosed with pulmonary embolism in the emergency department between January 2021 and December 2023 were retrospectively evaluated. Patients were stratified according to the presence of massive PE, one month mortality and pulmonary embolism severity index (PESI) score. Clinical, laboratory and radiographic parameters were compared to search for prognostic factors.

Results

Of the 210 patients, the mean age was 67 ± 15 years, 46 % were male, and 42 % had massive PE. The right/left ventricular volume ratio was significantly higher in patients with massive PE, in those who died within one month after admission; and in patients with PESI Class III. When the cut-off value of right/left ventricular volume ratio was accepted as >1.7, its predictive value for acute PE mortality was higher than other CTPA and echocardioraphy measurements (AUC = 0.706).

Conclusion

An increased right/left ventricular volume ratio on CTPA, a valuable tool for diagnosing right ventricular dysfunction, is associated with a worse prognosis in subjects with pulmonary thromboembolism.