Abstract 11603: Pulmonary Artery Dilation in Submassive Acute Pulmonary Embolus and Chronic Thromboembolic Pulmonary Hypertension

• Published in: Circulation (New York, N.Y.) N.Y.), 2021-11, Vol.144 (Suppl_1), p.A11603-A11603
• Main Authors: Dandawate, Nupur, Minhas, Jasleen, Nardelli, Pietro, San Jose Estepar, Ruben, Piazza, Gregory, Washko, George, San Jose Estepar, Raul, Rahaghi, Farbod
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.144.suppl_1.11603

IntroductionCT imaging is the primary mode of diagnosis of acute pulmonary embolus. At initial presentation, both patients with acute PE and undiagnosed decompensated CTEPH may present with similar clinical findings of presence of clot and RV dysfunction. Extraction of markers of disease from CT scans at the point of diagnosis may help with clinical decision making. In this study we compare two CT markers of disease severity in patients with submassive PE and CTEPH. We hypothesized that higher pressures and thus increased dilation of the pulmonary artery would be hemodynamically tolerated in the chronic disease. MethodsWe conducted a retrospective chart review study at Brigham and Women’s Hospital for patients with acute submassive PE between 2009-2017. Patients with adequate imaging and at least one positive right ventricular echocardiogram findings were included. The CTEPH cohort consisted of patients with CT imaging within one year of RHC proven CTEPH and patients from the submassive PE cohort found to have subsequently been diagnosed with CTEPH. The ratio of the main pulmonary artery (PA) to aorta (A) and RV to LV diameter ratio were measured by multiple operators to confirm reproducibility. All data collection was approved by the IRB at Mass General Brigham. Data was analyzed using R version 4.0.1 and Wilcoxon Rank-sum test with two-sided p-values for differences. Medians and interquartile ranges are reported. Results355 patients with the diagnosis of acute submassive PE and positive echo findings and 31 patients with CTEPH were included. Patients with acute PE were older (63 [53-73] vs 48 [41-67] p= 0.003) and had a similar fraction of females (190/355 vs 17/31). PAA was significantly higher in the CTEPH cohort (1.16 [0.97-1.32] vs 0.94 [0.85-1.04] p < 0.0001) as was the RV/LV ratio (1.44 [1.34-1.57] vs 1.31 [1.16-1.46]; p = 0.0005). ConclusionsPatients with CTEPH have a higher PA/A ratio than patients with submassive PE and echocardiographic signs of RV dysfunction. This study is limited in part because of the time between imaging and diagnosis of CTEPH, and lack of definitive follow-up for all acute PE cases. Prospective data collection would help evaluate clinical utility of CT markers in identifying chronic disease.