Prognostic value of Mastora obstruction score in acute pulmonary embolism

Traditionally massiveness of PE has been defined on the basis of angiographic burden of emboli by use of the radiologic indexes,such as Qanadli,Miller or Mastora obstruction score. Aim of the study: To evaluate the clinical significance of Mastora obstruction score in hemodynamic stable patients with acute PE. Materials and methods: 106 consecutive patients (43% men;mean age 68±14) with newly diagnosed acute PE,confirmed by CT angiography,were prospectively examined.PE severity was assessed by using Mastora obstruction score.Exclusion criteria were hemodynamic instability,sepsis,recurrent PE,surgery or trauma in acute period.According to Mastora obstruction score, patients were divided into 2 groups:patients with pulmonary vascular obstruction less than 50% (“non-massive” PE group) and patients with obstruction more than 50% of the pulmonary artery bed (“massive” PE group). Results: Cough (48%), fever (44%) and pleural effusion (48%) significantly occurred more often in “non-massive” PE group,while syncope(42%) and right ventricular dysfunction (86%) were more frequent in“massive” PE group. D-dimer concentration was significantly higher in “massive” PE group comparing with “non-massive” PE group. Whereas,CRP level was significantly higher in “non-massive” PE group.There were statistically significant correlation between Mastora obstruction score and CRP (p=0.007), D-dimer level(p=0.048), pleural effusion (p=0.049) and right ventricular dysfunction (p=0.003). Conclusions: The clinical manifestation depends on the massiveness of PE.Mastora obstruction score dividing into two groups (less or more than 50% of the pulmonary artery bed) shows two possible subtypes of PE:cardiovascular and respiratory.