Sex differences in the prognostic value of computed tomography pulmonary angiography parameters for intrahospital acute pulmonary embolism-related death.

Polno zavisne razlike u prognostičkom značaju parametara dobijenih kompjuterizovanom tomografskom angiografijom pluća za intrahospitalnu smrtnost kod akutne plućne embolije.

COMPUTED tomography; PULMONARY embolism; PROGNOSIS; MULTIDETECTOR computed tomography; ANGIOGRAPHY

Background/Aim. Multidetector computed tomography pulmonary angiography (MCTPA) has emerged as the most suitable method for diagnosing acute pulmonary embolism (APE) in hemodynamically stable patients. In addition to its diagnostic role, MCTPA facilitates the measurement and calculation of certain parameters that can be used as prognostic markers for outcomes in APE. Since the introduction of the method, there have been a lot of studies that pointed out there may be a significant difference in the prognostic value of MCTPA for APE concerning sex. Methods. The study population consisted of consecutive patients with a diagnosis of APE confirmed by MCTPA. Positive MCTPA findings and a diagnosis of APE were established if the patient had at least one segmental artery thrombus. APE severity was estimated using the simplified Pulmonary Embolism Severity Index (sPESI). Allcause and APE-related intrahospital deaths were the coprimary outcomes of this study. Results. In total, 1,612 patients were enrolled in the study (750 men and 862 women). Women with a centrally positioned pulmonary thrombus detected on MCTPA were more likely to die from PE-related death than those without one (10.4% vs. 4.2%, respectively; p = 0.016). Women with a right ventricle (RV) and left ventricle (LV) diameter ratio (RV/LV) > 1 died almost twice as often as those with a ratio ≤ 1 (15.5% vs. 8.6%, respectively; p = 0.017). Women with an RV/LV > 1 detected with MCTPA were significantly more likely to die from PE than those with a ratio ≤ 1 (11% vs. 5.2%, respectively; p = 0.017). Women who died from PE-related causes had a significantly higher value of the embolic burden score system (EBSS) than did the surviving women (18.00 vs. 11.00, respectively; p = 0.025). Independently of age, sPESI, and renal function, the presence of a central thrombus [odds ratio (OR) 2.278, 95% confidence interval (CI): 1.050–4.944, p = 0.037] and the RV/LV ratio > 1 (OR 2.015, 95% CI: 1.042–3.893, p = 0.037) were associated with intrahospital PE-related death in women. Conclusion. In women, MCTPA parameters, a centrally placed thrombus, the RV/LV ratio, and the EBSS had prognostic significance for PE-related mortality. The RV/LV ratio had prognostic significance for all-cause intrahospital mortality. In men, the MCTPA parameters had no prognostic significance for both overall and PErelated mortality. [ABSTRACT FROM AUTHOR]

Uvod/Cilj. Metoda multidetektorske kompjuterizovane tomografske angiografije pluća (MKTAP) se pokazala kao najpogodnija metoda za dijagnostikovanje akutne plućne embolije (APE) kod hemodinamski stabilnih bolesnika. Pored svoje dijagnostičke uloge, MKTAP olakšava merenje i izračunavanje određenih parametara koji se mogu koristiti kao prognostički markeri za ishode APE. Od uvođenja metode, urađen je veliki broj studija koje su ukazivale na to da može postojati značajna polno zavisna razlika u prognostičkoj vrednosti MKTAP u odnosu na ishod APE. Metode. Ispitivanu populaciju činili su konsekutivni bolesnici sa dijagnozom APE potvrđenom primenom MKTAP. Pozitivni MKTAP nalazi i dijagnoza APE postavljani su ako je bolesnik imao najmanje jedan tromb segmentne arterije. Težina APE procenjivana je korišćenjem indeksa simplified Pulmonary Embolism Severity Index (sPESI). Primarni ishodi ove studije bili su intrahospitalni smrtni ishodi nastali kao posledica APE i smrtni ishodi izazvani svim ostalim uzrocima. Rezultati. U studiju je ukupno bilo uključeno 1 612 bolesnika (750 muškaraca i 862 žene). Kod žena koje su imale centralno postavljeni tromb u plućima, otkriven putem MKTAP, zabeležena je veća učestalost intrahospitalnih smrtnih ishoda usled plućne embolije (PE), nego kod onih bez centralno postavljenog tromba (10,4% vs. 4,2%, redom; p = 0,016). Kod žena kod kojih je odnos između prečnika desne komore (DK) i leve komore (LK) (DK/LK) iznosio > 1, smrtnost je bila skoro dva puta češća od onih kod kojh je taj odnos bio ≤ 1 (15,5% vs. 8,6%, redom; p = 0,017). Kod žena kod kojih je odnos DK/LK, detektovan metodom MKTAP, iznosio > 1, verovatnoća smrtnog ishoda usled PE bila je značajno veća u poređenju sa ženama kod kojih je taj odnos bio ≤ 1 (11,0 % vs. 5,2%, redom; p = 0,017). Žene koje su umrle od posledica PE, imale su značajno višu vrednost skora embolijskog opterećenja (embolic burden score system - EBSS) nego žene koje su preživele (18,00 vs. 11,00, redom; p = 0,025). Nezavisno od starosti, sPESI i funkcije bubrega, prisustvo centralno postavljenog plućnog tromba [odds ratio – (OR) 2,278; 95% confidence interval – (CI): 1,050–4,944; p = 0,037] i odnos DK/LK > 1 (OR 2,015; 95% CI: 1,042–3,893, p = 0,037) bili su kod žena povezani sa intrahospitalnim smrtnim ishodom koji je nastao usled PE. Zaključak. Kod žena, parametri MKTAP, centralno postavljeni tromb, odnos DK/LK prečnika i EBSS imali su prognostički značaj za mortalitet zavisan od PE. Odnos prečnika DK i LK imao je prognostički značaj i za smrtnost izazavnu svim uzrocima, tokom hospitalizacije. Kod muškaraca, MKTAP parametri nisu imali prognostički značaj za ukupni mortalitet i smrtnost od PE. [ABSTRACT FROM AUTHOR]

Copyright of Vojnosanitetski Pregled: Military Medical & Pharmaceutical Journal of Serbia is the property of Military Medical Academy INI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)