Assessment of right ventricular dysfunction in acute pulmonary thromboembolism by using various scoring system
Journal Title: MedPulse -International Medical Journal - Year 2015, Vol 2, Issue 7
Abstract
Introduction: Pulmonary embolism is a serious and potentially fatal condition which is associated with significant morbidity and mortality. Diagnosis of pulmonary embolism continues to pose a challenge to both clinicians and radiologists because the clinical signs and symptoms of PE are non-specific. Mortality rate observed in pulmonary embolism is 2–7%, even when treated with anticoagulation. Aims and Objectives: To study and compare the various computed tomographic pulmonary thromboembolism scoring systems in predicting the right ventricular dysfunction in acute pulmonary thromboembolism. Materials and Methods: In the present study all patients who were diagnosed to have acute pulmonary embolism and confirmed by CT Pulmonary Angiogram. Patients who have previously been diagnosed and treated with pulmonary embolism in the past were excluded. Total 103 cases of acute pulmonary embolism were diagnosed in the present study during the study duration. Out of them 50 patients had RV dysfunction and 53 patients did not have RVD. All the patients included in the study were scanned on a 64-slice GE light speed VCT and 16-slice PHILIPS BRILLIANCE CT machines. Three pulmonary artery obstruction indices were calculated for each patient viz Miller, Walsh and Quanadli scoring systems. Results: Out of total 103 patients in the present study, 50 of them had RVD and 53 were not having RVD. According to Miller’s scoring system the mean score in RVD group was 11.92±4.38 whereas in non RVD group was 9.13±3.61 and the difference observed statistically significant. According to Welsh and Qanadli scoring system also the difference in RVD and non RVD group was statistically significant. The mean Pa diameter in RVD group was 28.38±4.29 whereas in non RVD group was 26.87±2.55 and the difference observed was statistically significant. RV/LV Ratio in RVD group was 1.144±0.23 and in non RVD group was 0.79±0.11 and the difference observed was also statistically significant. IVS bowing was observed in 13 cases in RVD group and one case in non RVD group. Conclusion: Thus the present study showed that the three angiogram based scoring system (Miller, Walsh and Qanadli) were able to accurately identify patients with RVD in acute pulmonary thromboembolism. Of these three scoring system the Qanadli score was the better predictor of RVD and it was the more reliable and easily reproducible scoring system.
Authors and Affiliations
Lokesh Tahnikavelu, Prabhu Radhan, Roy Santhosham, Ilanchezian Subramanyam, Venkata Sai
Keywords
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