Right ventricular enlargement on chest computed tomography - A predictor of early death in acute pulmonary embolism

Background - In patients with acute pulmonary embolism (PE), rapid and accurate risk assessment is paramount in selecting the appropriate treatment strategy. Right ventricular (RV) enlargement on chest CT has previously been shown to correlate with an unstable hospital course, but its role as a predictor of death is unknown. Methods and Results - We evaluated 431 consecutive patients (mean age, 59 +/- 16 years; 55% women) with acute PE confirmed by multidetector-row chest CT. With the use of multiplanar reformats of axial CT data, CT 4-chamber (4-CH) views were reconstructed and right and left ventricular dimensions (RVD, LVD) were measured. RV enlargement, defined as RVD/LVD > 0.9, was present in 276 (64.0%; 95% CI, 59.5% to 68.6%) patients. Thirty-day mortality rate was 15.6% (95% CI, 11.3% to 19.9%) in patients with and 7.7% (95% CI, 3.5% to 12.0%) without RV enlargement (log rank, P = 0.018). The hazard ratio of RVD/LVD > 0.9 for predicting 30-day death was 3.36 (95% CI, 1.13 to 9.97; P = 0.029). On multivariable analysis, RV enlargement predicted 30-day death (hazard ratio, 5.17; 95% CI, 1.63 to 16.35; P = 0.005) after adjusting for pneumonia (hazard ratio, 2.95; 95% CI, 1.19 to 3.83; P = 0.002), cancer (hazard ratio, 2.13; 95% CI, 1.19 to 3.83; P = 0.011), chronic lung disease (hazard ratio, 2.00; 95% CI, 1.04 to 3.86; P = 0.039), and age (hazard ratio, 1.03; 95% CI, 1.01 to 1.05; P = 0.005). Conclusions - In patients with acute PE, RV enlargement on reconstructed CT 4-CH view helps predict early death.