Elsevier

Indian Heart Journal

Volume 69, Issue 1, January–February 2017, Pages 68-74
Indian Heart Journal

Original Article
Comparison of PESI, echocardiogram, CTPA, and NT-proBNP as risk stratification tools in patients with acute pulmonary embolism

https://doi.org/10.1016/j.ihj.2016.07.010Get rights and content
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open access

Abstract

Objective

The aim of this study is to prospectively assess the diagnostic accuracy of pulmonary embolism severity index, echocardiogram, computed tomography pulmonary angiogram (CTPA), and N-terminal pro b-type natriuretic peptide (NT-proBNP) for predicting adverse events in acute pulmonary embolism patients.

Methods

Thirty consecutive acute pulmonary embolism patients were included in this study. Combined adverse events consisted of in-hospital death or use of escalation of care including cardiopulmonary resuscitation, mechanical ventilation, vasopressor therapy, or secondary thrombolysis during hospital stay.

Results

The outcomes were met in 30% of patients. Qanadli index (a measure of clot burden on CTPA) and NT-proBNP were significantly higher in patients with adverse events than those without (p = 0.005 and p = 0.009, respectively). PESI had moderate positive correlation with right ventricular dysfunction (RVD) (r = 0.449, p = 0.013) but there was no significant difference in PESI between patients with and without adverse events (p = 0.7). Receiver operating characteristic analysis indicated that Qanadli index was the best predictor of adverse events with area under the curve (AUC) of 0.807 (95% CI: 0.651–0.963) with a negative predictive value (NPV) of 100% and positive predictive value (PPV) of 47.4% at cut-off value of 19. Right ventricle to left ventricle ratio on CTPA was found to predict RVD with AUC of 0.94 (95% CI: 0.842–1.000), NPV (77.8%), and PPV (95.2%) at cut-off value at 1.15.

Conclusion

Qanadli index is more accurate predictor of adverse events than pulmonary embolism severity index, NT-proBNP, and RVD on echocardiogram and CTPA.

Keywords

Qanadli index
Pulmonary embolism
Echocardiogram
NT-proBNP
Right ventricle

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