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

AI Article Synopsis

  • - The study examined how well transthoracic echocardiography (TTE) and computed tomography pulmonary angiography (CTPA) work together to detect right ventricular dysfunction (RVD) in patients with pulmonary embolism (PE), finding moderate agreement between the two methods.
  • - Out of 258 patients, 71.3% had consistent results for RVD detection, with TTE showing higher specificity than CTPA, although both had perfect sensitivity for detecting adverse outcomes related to PE.
  • - The findings highlight that while TTE is more specific for identifying RVD, using a combination of CTPA parameters may enhance its effectiveness in detecting patients at higher risk for serious complications.

Article Abstract

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.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317779PMC
http://dx.doi.org/10.14744/AnatolJCardiol.2024.3562DOI Listing

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