Emile Ferrari*, Fabien Squara, Priscille Bouvier, Delphine Baudouy, Benjamin Sartre, Mohamed Labbaoui, Bernard Padovani, Charles Raffaeli and Pamela Moceri
Department of Cardiology and Radiology, Pasteur University Hospital, Nice, FranceFulltext PDF
Abstract Purpose: A reflux of contrast into the inferior vena cava and hepatic veins (RC) can be seen on Computed Tomographic Pulmonary Angiography (CTPA) of PE. In PE patients, we aimed to assess RC with a simplify score and study its relationship with other well-known markers of PE severity and patients’ outcomes. Methods: 384 consecutive patients with PE confirmed by CTPA were included between March 2016 and December 2019. RC was graded by two independent observers then classified, in a goal of simplification, in two groups of severity: “no or trivial” vs. “major”. The presence of RC was compared with other well-established prognosis parameters, in particular biomarkers and right ventricular dysfunction but also with early adverse outcomes defined as in-hospital clinical deterioration and mortality. Results: In our population of 384 PE, using the new classification, no or trivial RC was frequent (83.8%) while major RC was uncommon (16.2%). An adverse outcome occurred in 5.2% of patients (n=20). On multivariate analysis, negative anterior T waves on ECG, high BNP level and Right Ventricular (RV) dysfunction on transthoracic echocardiography were strongly and independently associated with the extent of reflux. A major RC appears to be a powerful parameter to predict outcomes (p=0.001) with a strong correlation with biomarkers: right ventricular echocardiographic dysfunction, but also clinical outcomes including mortality at 30 days. Conclusion: “Major” RC into the IVC and HV with a simplified classification is a radiologic sign to observe on CTPA of PE. It is strongly associated with PE severity in particular with biomarkers and right ventricular dysfunction and also short-term prognosis. It may help classify PE severity as soon as the diagnosis is done by CT scan.
Ferrari E, Squara F, Bouvier P, Baudouy D, Sartre B, Labbaoui M, et al. Assessment of a Simplified Score of Reflux of Contrast into the Inferior Vena Cava in Acute Pulmonary Embolism CT Scan: Correlation with PE Biomarkers, Right Ventricular Dysfunction and inHospital Mortality. Ann Cardiol Res Practice. 2020; 1(1): 1001..