ISSN 2149-2263 | E-ISSN 2149-2271
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Agreement Between Transthoracic Echocardiography and Computed Tomography Pulmonary Angiography for Detection of Right Ventricular Dysfunction in Pulmonary Embolism [Anatol J Cardiol]
Anatol J Cardiol. Ahead of Print: AJC-70524 | DOI: 10.14744/AnatolJCardiol.2024.3562

Agreement Between Transthoracic Echocardiography and Computed Tomography Pulmonary Angiography for Detection of Right Ventricular Dysfunction in Pulmonary Embolism

Serhat Erol1, Aslıhan Gürün Kaya1, Fatma Arslan1, Sümeyye Ayöz1, Ayşegül Gürsoy Çoruh2, Melahat Kul2, Evren Özçınar3, Aydın Çiledağ1, Zeynep Pınar Önen1, Akın Kaya1, Özlem Özdemir Kumbasar1, Stavros V. Konstantinides4
1Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Türkiye
2Department of Radiology, Ankara University Faculty of Medicine, Ankara, Türkiye
3Department of Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Türkiye
4Johannes Gutenberg University Mainz Center for Thrombosis and Hemostasis (CTH), Mainz, Germany

Background: Right ventricular dysfunction (RVD) is the main determinant of mortality in patients with pulmonary embolism (PE). Thus, guidelines recommend the assessment of RVD with transthoracic echocardiography (TTE) or computed tomography pulmonary angiography (CTPA) among these patients. In this study, we investigated the agreement between TTE and CTPA for the detection of RVD.

Methods: This single-center retrospective study included patients who were diagnosed with CTPA and underwent TTE within the first 24 hours following the diagnosis.

Results: Two hundred fifty-eight patients met the inclusion criteria. In 71.3% (184) of them, CTPA and TTE agreed on both the presence and absence of RVD. There was a moderate agreement between the 2 tests (Cohen’s kappa = 0.404, P <.001). The agreement between right ventricle dysfunction on TTE and the increased right ventricle/left ventricle (RV/LV) on CTPA was fair (Cohen’s kappa = 0.388, P <.001). Three patients died due to PE, and another 5 patients required urgent reperfusion therapy. Overall, adverse outcomes occurred in 4% (8) of patients. The sensitivity of modalities in the detection of adverse outcomes was 100%. Transthoracic echocardiography was more specific compared to CTPA (43% vs. 28%). Statistically, flattening/bulging of the interventricular septum on TTE was significantly associated with adverse outcomes. No individual CTPA parameter was related to adverse outcomes.

Conclusion: Both CTPA and TTE are reliable imaging modalities in the detection of RVD. However, TTE is more specific, and this may help in the identification and appropriate management of patients at higher risk of decompensation. A combination of CTPA parameters rather than individual RV/LV ratios increases the sensitivity of CTPA.

Keywords: Pulmonary embolism, risk stratification, prognosis, transthoracic echocardiography, computed tomography



Corresponding Author: Serhat Erol
Manuscript Language: English


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