Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Chest CT Parameters to Predict the Major Adverse Events in Acute Submassive Pulmonary Embolism

혈역학적으로 안정된 폐색전증 환자에서의 임상적 악화를 예측하는 전산화 단층촬영상 소견

  • Jung, Sang-Ku (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Won-Young (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Choong-Wook (Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Seo, Dong-Woo (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Youn-Sun (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jae-Ho (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Oh, Bum-Jin (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Won (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lim, Kyoung-Soo (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Sang-Bum (Department of Respiratory and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lim, Chae-Man (Department of Respiratory and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Koh, Youn-Suck (Department of Respiratory and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 정상구 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 김원영 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 이충욱 (울산대학교 의과대학 서울아산병원 영상의학교실) ;
  • 서동우 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 이윤선 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 이재호 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 오범진 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 김원 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 임경수 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 홍상범 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 임채만 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 고윤석 (울산대학교 의과대학 서울아산병원 호흡기내과학교실)
  • Received : 2010.07.16
  • Accepted : 2010.08.13
  • Published : 2010.09.30
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Abstract

Background: The purpose of this study was to determine the prognostic significance of chest computed tomographic (CT) parameters in acute submassive pulmonary embolism (PE). Methods: Between January 2006 and December 2009, 268 consecutive patients with acute submassive PE that was confirmed by chest CT with pulmonary angiography in emergency room were studied. One experienced radiologist measured CT parameters and judged the presence of right ventricular dysfunction. CT parameters were analyzed to determine their ability to predict a major adverse event (MAE). Results: There were 220 patients included and 61 (27.7%) had MAE. Left ventricular and right ventricular maximum minor axis ($36.4{\pm}8.0$ vs. $41.7{\pm}7.4$, p<0.01; $45.7{\pm}9.4$ vs. $41.5{\pm}7.6$, p<0.01), superior vena cava diameter ($19.2{\pm}3.4$ vs. $18.0{\pm}3.4$, p=0.02), azygos vein diameter ($10.0{\pm}2.2$ vs. $9.2{\pm}2.3$, p=0.02), septal displacement (19 vs. 18, p<0.01) were significantly higher in MAE group than in no MAE group. Patients with MAE had high right ventricular/left ventricular dimension ratio (RV/LV ratio) compared to patients without MAE ($1.34{\pm}0.48$ vs. $1.03{\pm}0.28$, p<0.01). The most useful cut-off value of RV/LV ratio for MAE was 1.3 and the area under the curve was 0.71 (0.62~0.79). Conclusion: RV/LV ratio on chest CT was a significant predictor of submassive PE related shock, intubation, in-hospital mortality, thrombolysis, thrombectomy within 30 days.

Keywords

References

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