CORRELATION OF EMBOLIC BURDEN AND RIGHT HEART DYSFUNCTION PARAMETERS WITH SHORT-TERM MORTALITY IN ACUTE PULMONARY EMBOLISM USING COMPUTED TOMOGRAPHY PULMONARY ANGIOGRAPHY

Abstract

Introduction: Various parameters, as identified on computed tomography pulmonary angiography (CTPA) in patients with acute pulmonary embolism (PE) are being used internationally to categorize patient into low or high risk to enhance choice of management by physicians. Data on Computed tomography (CT) pulmonary angiographic parameters as predictors of mortality in patients with acute pulmonary embolism and how they correlate with patient outcome in Ghana is minimal in comparison to developed countries. Aim: The main aim of the study was to identify the most significant parameter on CTPA that predicts short-term mortality in patients with acute PE. Material and Methods: The study was a prospective cross-sectional design assessing the right heart dysfunction parameters and clot/embolic burden as predictors of short term mortality in patients with Acute pulmonary embolism. 60 patients presenting to spectra health with CTPA findings consistent with acute PE were Conveniently sampled. Additionally, Student t-test and logistics regression were conducted to compare and predict the best radiological parameter for mortality. A chi-square test was used in addition to Fisher’s exact test at a 95% level of significance to test for the association of age and duration of death, age and outcome of patient. Results: Sixty patient (60) patients, comprising 26 (43.3%) males and 34 (56.67%) females were enrolled in the study with a mean age of 58 years which ranges from 29 years to 89 years. Out of the 60 patients, 20 (33.33%) died, 40 (66.66%) survived. Of all the parameters evaluated on CTPA, the Rv/Lv ratio (P-value 0.001), Rv diameter (P-value 0.003), and clot load score (P-value 0.001), were highly associated with short term mortality on bi-variate analysis. However, on multivariate analysis of Rv/Lv ratio (P-value 0.118), Rv diameter (P-value 0.381), and clot load (P-value 0.03), the clot load score was found to be the most significant parameter for predicting short term mortality. Conclusion: Right ventricular short axis diameter (Rv), Rv/Lv ratio (RV enlargement), and clot load score are significantly associated with short term mortality. The results of this present study, hopefully serve as a baseline upon which future studies build to improve outcomes in patients with acute PE.