Assessing the severity of pulmonary embolism among patients in the emergency department: Utility of RV/LV diameter ratio

Acute pulmonary embolism (APE) is a major cause of death from cardiovascular disease. Right ventricular systolic dysfunction (RVD) caused by APE is closely related to a poor outcome. Early risk stratification of APE is a vital step in prognostic assessment. The objective of this study was to investi...

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Veröffentlicht in:	PloS one 2020-11, Vol.15 (11), p.e0242340-e0242340
Hauptverfasser:	Cho, Sung-Uk, Cho, Young-Duck, Choi, Sung-Hyuk, Yoon, Young-Hoon, Park, Jong-Hak, Park, Sung-Joon, Lee, Eu-Sun
Format:	Artikel
Sprache:	eng
Schlagworte:	Aged Angiography Biology and Life Sciences Biomarkers Blood pressure Brain natriuretic peptide Calcium-binding protein Cardiovascular diseases Computed tomography Computed Tomography Angiography - methods Diagnosis Diameters Dyspnea Echocardiography Echocardiography - methods Embolism Embolisms Emergency medical care Emergency medical services Emergency Medical Services - methods Emergency Service, Hospital Female Health risks Heart Heart ventricles Heart Ventricles - diagnostic imaging Heart Ventricles - pathology Hospital emergency services Hospitals Humans Hypertension Hypertension - complications Male Medical examination Medical records Medicine Medicine and Health Sciences Middle Aged Mortality Natriuretic Peptide, Brain - blood Organ Size Peptide Fragments - blood Peptides Pulmonary arteries Pulmonary embolism Pulmonary Embolism - blood Pulmonary Embolism - diagnostic imaging Pulmonary Embolism - mortality Pulmonary Embolism - pathology Pulmonary embolisms Research and Analysis Methods Retrospective Studies Risk Risk Assessment Risk factors Sensitivity Severity of Illness Index Single-Blind Method Symptom Assessment - methods Troponin Troponin T Troponin T - blood Variables Ventricle
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description	Acute pulmonary embolism (APE) is a major cause of death from cardiovascular disease. Right ventricular systolic dysfunction (RVD) caused by APE is closely related to a poor outcome. Early risk stratification of APE is a vital step in prognostic assessment. The objective of this study was to investigate the usefulness of computed tomographic pulmonary angiography (CTPA) measured right ventricular (RV)/ left ventricular (LV) diameter ratio by the emergency department (ED) specialists for early risk stratification of APE patients in ED. The retrospective data of 229 APE patients were reviewed. Two ED specialists measured both RV and LV diameters on a single transverse scan perpendicular to the long axis of the heart. The patients were divided into two groups, RV/LV diameter ratio 1. CTPA measured RV/LV diameter ratio were analyzed and compared with sPESI score, cardiac biomarkers such as N-Terminal Pro-B-Type Natriuretic Peptide (NT-pro-BNP), high sensitivity cardiac troponin T (hs-cTnT), and RVD measured by echocardiography (Echo). The mean age in RV/LV > 1 group was significantly higher than that of the other group (67.81±2.7 years vs. 60.68±3.2 years). Also, there were more hypertension patients (44.4% vs. 33.3%), and mean arterial pressure (MAP) was lower. A significantly higher ICU admission rate (28.05% vs. 11.61%) was shown in RV/LV >1 group, and five patients expired only in RV/LV > 1 group. RVD by Echo demonstrated the highest sensitivity, specificity, and negative predictive value (NPV) (values of 94.3%, 81.1%, 95.5%). RV/LV >1 diameter ratio by CTPA showed usefulness equivalent to cardiac biomarkers. RV/LV >1 patients' cardiac enzymes were higher, and there were more RVD in RV/LV >1 group. Simple measurement of RV/LV diameter ratio by ED specialist would be a help to the clinicians in identifying and stratifying the risk of the APE patients presenting in the ED.
doi_str_mv	10.1371/journal.pone.0242340
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Right ventricular systolic dysfunction (RVD) caused by APE is closely related to a poor outcome. Early risk stratification of APE is a vital step in prognostic assessment. The objective of this study was to investigate the usefulness of computed tomographic pulmonary angiography (CTPA) measured right ventricular (RV)/ left ventricular (LV) diameter ratio by the emergency department (ED) specialists for early risk stratification of APE patients in ED. The retrospective data of 229 APE patients were reviewed. Two ED specialists measured both RV and LV diameters on a single transverse scan perpendicular to the long axis of the heart. The patients were divided into two groups, RV/LV diameter ratio <1 and ratio >1. CTPA measured RV/LV diameter ratio were analyzed and compared with sPESI score, cardiac biomarkers such as N-Terminal Pro-B-Type Natriuretic Peptide (NT-pro-BNP), high sensitivity cardiac troponin T (hs-cTnT), and RVD measured by echocardiography (Echo). The mean age in RV/LV > 1 group was significantly higher than that of the other group (67.81±2.7 years vs. 60.68±3.2 years). Also, there were more hypertension patients (44.4% vs. 33.3%), and mean arterial pressure (MAP) was lower. A significantly higher ICU admission rate (28.05% vs. 11.61%) was shown in RV/LV >1 group, and five patients expired only in RV/LV > 1 group. RVD by Echo demonstrated the highest sensitivity, specificity, and negative predictive value (NPV) (values of 94.3%, 81.1%, 95.5%). RV/LV >1 diameter ratio by CTPA showed usefulness equivalent to cardiac biomarkers. RV/LV >1 patients' cardiac enzymes were higher, and there were more RVD in RV/LV >1 group. Simple measurement of RV/LV diameter ratio by ED specialist would be a help to the clinicians in identifying and stratifying the risk of the APE patients presenting in the ED.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0242340</identifier><identifier>PMID: 33211719</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Angiography ; Biology and Life Sciences ; Biomarkers ; Blood pressure ; Brain natriuretic peptide ; Calcium-binding protein ; Cardiovascular diseases ; Computed tomography ; Computed Tomography Angiography - methods ; Diagnosis ; Diameters ; Dyspnea ; Echocardiography ; Echocardiography - methods ; Embolism ; Embolisms ; Emergency medical care ; Emergency medical services ; Emergency Medical Services - methods ; Emergency Service, Hospital ; Female ; Health risks ; Heart ; Heart ventricles ; Heart Ventricles - diagnostic imaging ; Heart Ventricles - pathology ; Hospital emergency services ; Hospitals ; Humans ; Hypertension ; Hypertension - complications ; Male ; Medical examination ; Medical records ; Medicine ; Medicine and Health Sciences ; Middle Aged ; Mortality ; Natriuretic Peptide, Brain - blood ; Organ Size ; Peptide Fragments - blood ; Peptides ; Pulmonary arteries ; Pulmonary embolism ; Pulmonary Embolism - blood ; Pulmonary Embolism - diagnostic imaging ; Pulmonary Embolism - mortality ; Pulmonary Embolism - pathology ; Pulmonary embolisms ; Research and Analysis Methods ; Retrospective Studies ; Risk ; Risk Assessment ; Risk factors ; Sensitivity ; Severity of Illness Index ; Single-Blind Method ; Symptom Assessment - methods ; Troponin ; Troponin T ; Troponin T - blood ; Variables ; Ventricle</subject><ispartof>PloS one, 2020-11, Vol.15 (11), p.e0242340-e0242340</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Cho et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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Right ventricular systolic dysfunction (RVD) caused by APE is closely related to a poor outcome. Early risk stratification of APE is a vital step in prognostic assessment. The objective of this study was to investigate the usefulness of computed tomographic pulmonary angiography (CTPA) measured right ventricular (RV)/ left ventricular (LV) diameter ratio by the emergency department (ED) specialists for early risk stratification of APE patients in ED. The retrospective data of 229 APE patients were reviewed. Two ED specialists measured both RV and LV diameters on a single transverse scan perpendicular to the long axis of the heart. The patients were divided into two groups, RV/LV diameter ratio <1 and ratio >1. CTPA measured RV/LV diameter ratio were analyzed and compared with sPESI score, cardiac biomarkers such as N-Terminal Pro-B-Type Natriuretic Peptide (NT-pro-BNP), high sensitivity cardiac troponin T (hs-cTnT), and RVD measured by echocardiography (Echo). The mean age in RV/LV > 1 group was significantly higher than that of the other group (67.81±2.7 years vs. 60.68±3.2 years). Also, there were more hypertension patients (44.4% vs. 33.3%), and mean arterial pressure (MAP) was lower. A significantly higher ICU admission rate (28.05% vs. 11.61%) was shown in RV/LV >1 group, and five patients expired only in RV/LV > 1 group. RVD by Echo demonstrated the highest sensitivity, specificity, and negative predictive value (NPV) (values of 94.3%, 81.1%, 95.5%). RV/LV >1 diameter ratio by CTPA showed usefulness equivalent to cardiac biomarkers. RV/LV >1 patients' cardiac enzymes were higher, and there were more RVD in RV/LV >1 group. Simple measurement of RV/LV diameter ratio by ED specialist would be a help to the clinicians in identifying and stratifying the risk of the APE patients presenting in the ED.</description><subject>Aged</subject><subject>Angiography</subject><subject>Biology and Life Sciences</subject><subject>Biomarkers</subject><subject>Blood pressure</subject><subject>Brain natriuretic peptide</subject><subject>Calcium-binding protein</subject><subject>Cardiovascular diseases</subject><subject>Computed tomography</subject><subject>Computed Tomography Angiography - methods</subject><subject>Diagnosis</subject><subject>Diameters</subject><subject>Dyspnea</subject><subject>Echocardiography</subject><subject>Echocardiography - methods</subject><subject>Embolism</subject><subject>Embolisms</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Emergency Medical Services - methods</subject><subject>Emergency Service, Hospital</subject><subject>Female</subject><subject>Health risks</subject><subject>Heart</subject><subject>Heart ventricles</subject><subject>Heart Ventricles - diagnostic imaging</subject><subject>Heart Ventricles - pathology</subject><subject>Hospital emergency services</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension - complications</subject><subject>Male</subject><subject>Medical examination</subject><subject>Medical records</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Natriuretic Peptide, Brain - blood</subject><subject>Organ Size</subject><subject>Peptide Fragments - blood</subject><subject>Peptides</subject><subject>Pulmonary arteries</subject><subject>Pulmonary embolism</subject><subject>Pulmonary Embolism - blood</subject><subject>Pulmonary Embolism - diagnostic imaging</subject><subject>Pulmonary Embolism - mortality</subject><subject>Pulmonary Embolism - pathology</subject><subject>Pulmonary embolisms</subject><subject>Research and Analysis Methods</subject><subject>Retrospective Studies</subject><subject>Risk</subject><subject>Risk Assessment</subject><subject>Risk factors</subject><subject>Sensitivity</subject><subject>Severity of Illness Index</subject><subject>Single-Blind Method</subject><subject>Symptom Assessment - 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blood</topic><topic>Peptides</topic><topic>Pulmonary arteries</topic><topic>Pulmonary embolism</topic><topic>Pulmonary Embolism - blood</topic><topic>Pulmonary Embolism - diagnostic imaging</topic><topic>Pulmonary Embolism - mortality</topic><topic>Pulmonary Embolism - pathology</topic><topic>Pulmonary embolisms</topic><topic>Research and Analysis Methods</topic><topic>Retrospective Studies</topic><topic>Risk</topic><topic>Risk Assessment</topic><topic>Risk factors</topic><topic>Sensitivity</topic><topic>Severity of Illness Index</topic><topic>Single-Blind Method</topic><topic>Symptom Assessment - methods</topic><topic>Troponin</topic><topic>Troponin T</topic><topic>Troponin T - blood</topic><topic>Variables</topic><topic>Ventricle</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cho, Sung-Uk</creatorcontrib><creatorcontrib>Cho, Young-Duck</creatorcontrib><creatorcontrib>Choi, Sung-Hyuk</creatorcontrib><creatorcontrib>Yoon, Young-Hoon</creatorcontrib><creatorcontrib>Park, Jong-Hak</creatorcontrib><creatorcontrib>Park, Sung-Joon</creatorcontrib><creatorcontrib>Lee, Eu-Sun</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cho, Sung-Uk</au><au>Cho, Young-Duck</au><au>Choi, Sung-Hyuk</au><au>Yoon, Young-Hoon</au><au>Park, Jong-Hak</au><au>Park, Sung-Joon</au><au>Lee, Eu-Sun</au><au>Lazzeri, Chiara</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessing the severity of pulmonary embolism among patients in the emergency department: Utility of RV/LV diameter ratio</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2020-11-19</date><risdate>2020</risdate><volume>15</volume><issue>11</issue><spage>e0242340</spage><epage>e0242340</epage><pages>e0242340-e0242340</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Acute pulmonary embolism (APE) is a major cause of death from cardiovascular disease. Right ventricular systolic dysfunction (RVD) caused by APE is closely related to a poor outcome. Early risk stratification of APE is a vital step in prognostic assessment. The objective of this study was to investigate the usefulness of computed tomographic pulmonary angiography (CTPA) measured right ventricular (RV)/ left ventricular (LV) diameter ratio by the emergency department (ED) specialists for early risk stratification of APE patients in ED. The retrospective data of 229 APE patients were reviewed. Two ED specialists measured both RV and LV diameters on a single transverse scan perpendicular to the long axis of the heart. The patients were divided into two groups, RV/LV diameter ratio <1 and ratio >1. CTPA measured RV/LV diameter ratio were analyzed and compared with sPESI score, cardiac biomarkers such as N-Terminal Pro-B-Type Natriuretic Peptide (NT-pro-BNP), high sensitivity cardiac troponin T (hs-cTnT), and RVD measured by echocardiography (Echo). The mean age in RV/LV > 1 group was significantly higher than that of the other group (67.81±2.7 years vs. 60.68±3.2 years). Also, there were more hypertension patients (44.4% vs. 33.3%), and mean arterial pressure (MAP) was lower. A significantly higher ICU admission rate (28.05% vs. 11.61%) was shown in RV/LV >1 group, and five patients expired only in RV/LV > 1 group. RVD by Echo demonstrated the highest sensitivity, specificity, and negative predictive value (NPV) (values of 94.3%, 81.1%, 95.5%). RV/LV >1 diameter ratio by CTPA showed usefulness equivalent to cardiac biomarkers. RV/LV >1 patients' cardiac enzymes were higher, and there were more RVD in RV/LV >1 group. Simple measurement of RV/LV diameter ratio by ED specialist would be a help to the clinicians in identifying and stratifying the risk of the APE patients presenting in the ED.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33211719</pmid><doi>10.1371/journal.pone.0242340</doi><tpages>e0242340</tpages><orcidid>https://orcid.org/0000-0002-0213-311X</orcidid><oa>free_for_read</oa></addata></record>
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subjects	Aged Angiography Biology and Life Sciences Biomarkers Blood pressure Brain natriuretic peptide Calcium-binding protein Cardiovascular diseases Computed tomography Computed Tomography Angiography - methods Diagnosis Diameters Dyspnea Echocardiography Echocardiography - methods Embolism Embolisms Emergency medical care Emergency medical services Emergency Medical Services - methods Emergency Service, Hospital Female Health risks Heart Heart ventricles Heart Ventricles - diagnostic imaging Heart Ventricles - pathology Hospital emergency services Hospitals Humans Hypertension Hypertension - complications Male Medical examination Medical records Medicine Medicine and Health Sciences Middle Aged Mortality Natriuretic Peptide, Brain - blood Organ Size Peptide Fragments - blood Peptides Pulmonary arteries Pulmonary embolism Pulmonary Embolism - blood Pulmonary Embolism - diagnostic imaging Pulmonary Embolism - mortality Pulmonary Embolism - pathology Pulmonary embolisms Research and Analysis Methods Retrospective Studies Risk Risk Assessment Risk factors Sensitivity Severity of Illness Index Single-Blind Method Symptom Assessment - methods Troponin Troponin T Troponin T - blood Variables Ventricle
title	Assessing the severity of pulmonary embolism among patients in the emergency department: Utility of RV/LV diameter ratio
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