Sex differences in the prognostic value of computed tomography pulmonary angiography parameters for intrahospital acute pulmonary embolism-related death
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 p...
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Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2024-01-01
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| Series: | Vojnosanitetski Pregled |
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| Online Access: | https://doiserbia.nb.rs/img/doi/0042-8450/2024/0042-84502400023B.pdf |
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| author | Bošković-Sekulić Jelena Sekulić Igor Džudović Boris Subotić Bojana Salinger Sonja Matijašević Jovan Kovačević Tamara Mitevska Irena Miloradović Vladimir Nešković Aleksandar Obradović Slobodan |
| author_facet | Bošković-Sekulić Jelena Sekulić Igor Džudović Boris Subotić Bojana Salinger Sonja Matijašević Jovan Kovačević Tamara Mitevska Irena Miloradović Vladimir Nešković Aleksandar Obradović Slobodan |
| author_sort | Bošković-Sekulić Jelena |
| collection | DOAJ |
| description | 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). All-cause 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 PE-related mortality. |
| format | Article |
| id | doaj-art-8482b5bacaac4c5e84775a72beaa261f |
| institution | DOAJ |
| issn | 0042-8450 2406-0720 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade |
| record_format | Article |
| series | Vojnosanitetski Pregled |
| spelling | doaj-art-8482b5bacaac4c5e84775a72beaa261f2025-08-20T03:07:13ZengMinistry of Defence of the Republic of Serbia, University of Defence, BelgradeVojnosanitetski Pregled0042-84502406-07202024-01-0181531031710.2298/VSP240109023B0042-84502400023BSex differences in the prognostic value of computed tomography pulmonary angiography parameters for intrahospital acute pulmonary embolism-related deathBošković-Sekulić Jelena0https://orcid.org/0000-0002-1104-7344Sekulić Igor1https://orcid.org/0000-0002-8016-5184Džudović Boris2https://orcid.org/0000-0001-9665-6052Subotić Bojana3Salinger Sonja4https://orcid.org/0000-0001-9657-1665Matijašević Jovan5https://orcid.org/0000-0002-2476-0763Kovačević Tamara6Mitevska Irena7https://orcid.org/0000-0002-2774-8559Miloradović Vladimir8https://orcid.org/0000-0001-5813-6769Nešković Aleksandar9https://orcid.org/0000-0001-8617-966XObradović Slobodan10https://orcid.org/0000-0001-5711-5851University Clinical Center Kragujevac, Clinic of Emergency Medicine, Kragujevac, SerbiaMilitary Medical Academy, Institute for Radiology, Belgrade, Serbia + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, SerbiaUniversity of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia + Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, SerbiaMilitary Medical Academy, Clinic for Cardiology, Belgrade, SerbiaUniversity Clinical Center Niš, Clinic of Cardiology, Niš, Serbia + University of Niš, Faculty of Medicine, Niš , SerbiaInstitute of Pulmonary Diseases Vojvodina, Novi Sad, Serbia + University of Novi Sad, Faculty of Medicine, Novi Sad, SerbiaClinical Center Banja Luka, Clinic of Cardiology, Banja Luka, Republic of Srpska, Bosnia and Herzegovina + University of Banja Luka, Faculty of Medicine, Banja Luka, Republic of Srpska, Bosnia and HerzegovinaUniversity Cardiology Clinic, Intensive Care Unit, Skopje, North MacedoniaUniversity Clinical Center Kragujevac, Clinic of Cardiology, Kragujevac, Serbia + University of Kragujevac, Faculty of Medical Sciences, Kragujevac, SerbiaUniversity Clinical Hospital Center Zemun, Clinic of Cardiology, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade , SerbiaUniversity of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia + Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, SerbiaBackground/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). All-cause 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 PE-related mortality.https://doiserbia.nb.rs/img/doi/0042-8450/2024/0042-84502400023B.pdfcomputed tomography angiographymortalitymultidetector computed tomographypulmonary embolismsextreatment outcome |
| spellingShingle | Bošković-Sekulić Jelena Sekulić Igor Džudović Boris Subotić Bojana Salinger Sonja Matijašević Jovan Kovačević Tamara Mitevska Irena Miloradović Vladimir Nešković Aleksandar Obradović Slobodan Sex differences in the prognostic value of computed tomography pulmonary angiography parameters for intrahospital acute pulmonary embolism-related death Vojnosanitetski Pregled computed tomography angiography mortality multidetector computed tomography pulmonary embolism sex treatment outcome |
| title | Sex differences in the prognostic value of computed tomography pulmonary angiography parameters for intrahospital acute pulmonary embolism-related death |
| title_full | Sex differences in the prognostic value of computed tomography pulmonary angiography parameters for intrahospital acute pulmonary embolism-related death |
| title_fullStr | Sex differences in the prognostic value of computed tomography pulmonary angiography parameters for intrahospital acute pulmonary embolism-related death |
| title_full_unstemmed | Sex differences in the prognostic value of computed tomography pulmonary angiography parameters for intrahospital acute pulmonary embolism-related death |
| title_short | Sex differences in the prognostic value of computed tomography pulmonary angiography parameters for intrahospital acute pulmonary embolism-related death |
| title_sort | sex differences in the prognostic value of computed tomography pulmonary angiography parameters for intrahospital acute pulmonary embolism related death |
| topic | computed tomography angiography mortality multidetector computed tomography pulmonary embolism sex treatment outcome |
| url | https://doiserbia.nb.rs/img/doi/0042-8450/2024/0042-84502400023B.pdf |
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