Background: Acute pulmonary embolism (PE) is a common disease with a high mortality. Computed tomographic pulmonary angiography (CTPA) represents the current gold standard for the evaluation of patients with suspected PE.
Purpose: To search possible CTPA predictors of 24-h and 30-day mortality in PE.
Material And Methods: Overall, 224 patients with PE (46.4% women, mean age 64.7 ± 16.7 years) were acquired. CTPA was performed on a multi-slice CT scanner. The following radiological parameters were estimated: thrombotic obstruction index; diameter of the pulmonary trunk (mm); short axis ratio of right ventricle/left ventricle; diameter of the azygos vein (mm); diameter of the superior and inferior vena cava (mm); and reflux of contrast medium into the inferior vena cava (IVC).
Results: Patients who died within the first 24 h after admission (n = 32, 14.3%) showed a reflux grade 3 into IVC more often than survivors (odds ratio [OR] 7.6, 95% confidence interval [CI] 3.3-17.7; < 0.001). Other relevant CTPA parameters were diameter of IVC (OR 1.1, 95% CI 1.01-1.21; = 0.034) and diameter of the pulmonary trunk (OR 0.91, 95% CI 0.82-1.01, = 0.074), whereas the Mastora score showed nearly no influence (OR 1.01, 95% CI 0.99-1.02, = 0.406). Furthermore, 61 (27.2%) patients died within the first 30 days after admission. These patients showed a reflux grade 3 into IVC more often than survivors (OR 3.4, 95% CI 1.7-7.0; = 0.001). Other CTPA parameters, such as diameter of IVC (OR 1.04, 95% CI 0.97-1.12; = 0.277) and diameter of the pulmonary trunk (OR 0.96, 95% CI 0.89-1.04; = 0.291), seem to have no relevant influence, whereas Mastora score did (OR 0.99, 95% CI 0.976-0.999, = 0.045).
Conclusion: Subhepatic contrast reflux into IVC is a strong predictor of 24-h and 30-day mortality in patients with acute PE.
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