CORRELATION OF QANADLI SCORE WITH RIGHT VENTRICULAR DYSFUNCTION IN PATIENTS WITH ACUTE PULMONARY EMBOLISM

  • Nasir Khan Department of Diagnostic Imaging, Rawalpindi Medical College and Allied Hospitals, Rawalpindi, Pakistan
  • Anam Zahoor Department of Radiology, Holy Family Hospital, Rawalpindi, Pakistan
  • Ghayyur Khan Department of Radiology, Ayub Medical College, Abbottabad, Pakistan

Abstract

Background: CT-pulmonary angiography (CTPA) is routinely performed in patients with suspected pulmonary embolism (PE) and a positive relationship between Qanadli score (Q-score) and RV-dysfunction enables the clinicians in early diagnosis and management of RV-dysfunction on the basis of this single imaging modality. Objective of the study was to determine the correlation between an established angiographic clot burden score (Qanadli score-QS) and parameters of right ventricular dysfunction (RVD) on CT pulmonary angiography in patients with acute pulmonary embolism. Methods: A Cross-sectional study was carried out for the period of six months from 16 Jun to 15 Dec 2016. Total of forty-six (46) patients of either gender aged 15–70 years with confirmed evidence of PE were recruited. The Q-score and parameters of RV-dysfunction (LV/RV, ratio, SVC diameter, AV-diameter and PA/Ao ratio) were calculated in each patient. Correlation between Q-Score and RV parameters were determined and binary logistic regression analysis was applied to assess Q-score as an independent predictor of RV-dysfunction. Results: Avery strong positive correlation was found between Q-score and LV/RV ratio (r>0.7, p<0.05) collectively and after gender and age based stratification.  No significant correlation was found between Q-score and other RV parameters among both genders and age groups (p>0.05 in all cases). No independent factors were found to be significantly related to RV dysfunction after adjustment for other factors (p>0.05). Conclusion: Qanadli score on CT pulmonary angiogram correlates positively with indicators of right ventricular dysfunction of CT angiogram in patients with acute pulmonary embolism and confer a poor prognosis with higher scores.


Keywords: Pulmonary Embolism, CTPA, RV dysfunction


Pak J Physiol 2017;13(4):14–7

References

1. Subramaniam RM, Mandrekar J, Chang C, Blair D, Gilbert K, Peller PJ, et al. Pulmonary embolism outcome: a prospective evaluation of CT pulmonary angiographic clot burden score and ECG score. Am J Roentgenol 2008;190(6):1599–604.
2. Oger E. Incidence of venous thromboembolism: a community-based study in Western France. EPI-GETBP Study Group. Grouped’Etude de la Thrombose de Bretagne Occidentale. Thromb Haemost 2000;83(5):657–60.
3. Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, et al. Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2008;29(18):2276–315.
4. Meignan M, Rosso J, Gauthier H, Brunengo F, Claudel S, Sagnard L, et al. Systematic lung scans reveal a high frequency of silent pulmonary embolism in patients with proximal deep venous thrombosis. Arch Intern Med 2000;160(2):159–64.
5. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999;353(9162):1386–9.
6. Wood KE. Major pulmonary embolism: review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism. Chest 2002;121:877–905.
7. Araoz PA, Gotway MB, Harrington JR, Harmsen WS, Mandrekar JN. Pulmonary Embolism: Prognostic CT Findings. Radiol 2007;242(3):889–97.
8. Goldhaber SZ. Echocardiography in the management of pulmonary embolism. Ann Intern Med 2002;136:691–700.
9. Venkatesh SK, Wang SC. Central clot score at computed tomography as a predictor of 30-day mortality after acute pulmonary embolism. Ann Acad Med Singapore 2010;39:442–7.
10. Contractor S, Maldjian PD, Sharma VK, Gor DM. Role of helical CT in detecting right ventricular dysfunction secondary to acute pulmonary embolism. J Comput Assist Tomogr 2002;26:587–91.
11. Reid JH, Murchison JT. Acute right ventricular dilatation: a new helical CT sign of massive pulmonary embolism. Clin Radiol 1998;53(9):694–8.
12. Aribas A, Keskin S, Akilli H, Kayrak M, Erdogan HI, Guler I, et al. The use of axial diameters and CT obstruction scores for determining echocardiographic right ventricular dysfunction in patients with acute pulmonary embolism. Jpn J Radiol 2014;32:451–60.
13. Qanadli SD, El Hajjam M, Vieillard-Baron A, Joseph T, Mesurolle B, Oliva VL, et al. New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography. Am J Roentgenol 2001;176(6):1415–20.
14. Collomb D, Paramelle PJ, Calaque O, Bosson JL, Vanzetto G, Barnoud D, et al. Severity assessment of acute pulmonary embolism: evaluation using helical CT. Eur Radiol 2003;13:1508–14.
15. van der Meer RW, Pattynama PM, van Strijen MJ, van den Berg-Huijsmans AA, Hartmann IJ, Putter H, et al. Right ventricular dysfunction and pulmonary obstruction index at helical CT: prediction of clinical outcome during 3-month follow-up in patients with acute pulmonary embolism. Radiol 2005;235:798–803.
16. Lim KE, Chan CY, Chu PH, Hsu YY, Hsu WC. Right ventricular dysfunction secondary to acute massive pulmonary embolism detected by helical computed tomography pulmonary angiography. Clin Imaging 2005;29(1):16–21.
17. Araoz PA, Gotway MB, Trowbridge RL, Bailey RA, Auerbach AD, Reddy GP, et al. Helical CT pulmonary angiography predictors of in-hospital morbidity and mortality in patients with acute pulmonary embolism. J Thorac Imaging 2003;18:207–16.
18. Nazerian P, Vanni S, Volpicelli G, Gigli C, Zanobetti M, Bartolucci M, et al. Accuracy of point-of-care multiorgan ultrasonography for the diagnosis of pulmonary embolism. Chest 2014;145:950–7.
19. Moreno FL, Hagan AD, Holmen JR, Pryor TA, Strickland RD, Castle CH. Evaluation of size and dynamics of the inferior vena cava as an index of right-sided cardiac function. Am J Cardiol 1984;53:579–85.
20. Kircher BJ, Himelman RB, Schiller NB. Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol 1990;66:493–6.
21. Nural MS, Elmali M, Findik S, Yapici O, Uzun O, Sunter AT, Erkan L. Computed tomographic pulmonary angiography in the assessment of severity of acute pulmonary embolism and right ventricular dysfunction. Acta Radiol 2009;50:629–37.
22. Apfaltrer P, Henzler T, Meyer M, Roeger S, Haghi D, Gruettner J, et al. Correlation of CT angiographic pulmonary artery obstruction scores with right ventricular dysfunction and clinical outcome in patients with acute pulmonary embolism. Eur J Radiol 2012;81:2867–71.
Published
2017-12-31
How to Cite
KHAN, Nasir; ZAHOOR, Anam; KHAN, Ghayyur. CORRELATION OF QANADLI SCORE WITH RIGHT VENTRICULAR DYSFUNCTION IN PATIENTS WITH ACUTE PULMONARY EMBOLISM. Pakistan Journal of Physiology, [S.l.], v. 13, n. 4, p. 14-17, dec. 2017. ISSN 2073-1183. Available at: <http://pjp.pps.org.pk/index.php/PJP/article/view/92>. Date accessed: 17 feb. 2018.

Most read articles by the same author(s)

Obs.: This plugin requires at least one statistics/report plugin to be enabled. If your statistics plugins provide more than one metric then please also select a main metric on the admin's site settings page and/or on the journal manager's settings pages.