Moderated Posters session * Cardiovascular computed tomography, magnetic resonance and nuclear imaging: 13/12/2013, 08:30-12:30 * Location: Moderated Poster area

Purpose: A left-bulging atrial septum (AS) in diastole is an abnormal sign indicating hemodynamic overloading of the right heart. Main hypothesis is computed tomography (CT)-derived AS bulging and ventricular septum (VS) bowing signs would be used to identify patients with acute pulmonary embolism (PE) and significant hemodynamic derangements. Methods: In the prospective registry, 221 consecutive patients with a first episode of acute PE diagnosed by chest CT were grouped by clinical hemodynamic assessment: massive or submassive PE (Group 1), and small PE (Group 2). The curvatures of the AS and VS, right ventricle (RV) and left ventricle (LV) diameters were measured on chest CT. Results: Group 1 showed higher degrees of RV dilatation, and abnormal VS and AS curvatures versus Group2. The sensitivity and specificity of a CT-derived RVD/LVD ratio >0.9 for predicting PE with clinically significant RV dysfunction were 60.8% and 69.7%, respectively. An abnormal VS bowing sign was observed in 33 (32.4%) and 7 (5.9%) patients in Groups 1 and 2, respectively (p<0.001). An abnormal AS bulging sign was observed in 62 (60.8%) and 35 (29.4%) patients in Groups 1 and 2, respectively (p<0.001). On the basis of the CT-derived RVD/LVD ratio, VS bowing, and AS bulging status, patients with acute PE were classified into three risk groups: higher risk, lower risk, and intermediate risk. An algorithm was designed to predict clinically significant hemodynamic abnormality based on these signs (Figure); patients deemed "higher risk" exhibited higher 90-day all-cause mortality than patients in the lower-risk group (p=0.028). Conclusions: Conventional chest CT-derived hemodynamic findings, including abnormal AS and VS signs, can be used to identify high-risk patients with acute PE and to predict early mortality.<cross-ref type="fig" refid="CHAPTERsub50711F1"></cross-ref> <fig loc="float" id="CHAPTERsub50711F1"> <link locator="13350120130531123812"></fig>