Contrast reflux into the inferior vena cava on computer tomographic pulmonary angiography is a predictor of 24-hour and 30-day mortality in patients with acute pulmonary embolism.

Nikolaos Bailis, Marianne Lerche, Hans Jonas Meyer, Andreas Wienke, Alexey Surov

Acta radiologica (Stockholm, Sweden : 1987) 2021 Jan

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Acute pulmonary embolism (PE) is a common disease with a high mortality. Computed tomographic pulmonary angiography (CTPA) represents the current gold standard for the evaluation of patients with suspected PE. To search possible CTPA predictors of 24-h and 30-day mortality in PE. Overall, 224 patients with PE (46.4% women, mean age 64.7 ± 16.7 years) were acquired. CTPA was performed on a multi-slice CT scanner. The following radiological parameters were estimated: thrombotic obstruction index; diameter of the pulmonary trunk (mm); short axis ratio of right ventricle/left ventricle; diameter of the azygos vein (mm); diameter of the superior and inferior vena cava (mm); and reflux of contrast medium into the inferior vena cava (IVC). Patients who died within the first 24 h after admission (n = 32, 14.3%) showed a reflux grade 3 into IVC more often than survivors (odds ratio [OR] 7.6, 95% confidence interval [CI] 3.3-17.7; P < 0.001). Other relevant CTPA parameters were diameter of IVC (OR 1.1, 95% CI 1.01-1.21; P = 0.034) and diameter of the pulmonary trunk (OR 0.91, 95% CI 0.82-1.01, P = 0.074), whereas the Mastora score showed nearly no influence (OR 1.01, 95% CI 0.99-1.02, P = 0.406). Furthermore, 61 (27.2%) patients died within the first 30 days after admission. These patients showed a reflux grade 3 into IVC more often than survivors (OR 3.4, 95% CI 1.7-7.0; P = 0.001). Other CTPA parameters, such as diameter of IVC (OR 1.04, 95% CI 0.97-1.12; P = 0.277) and diameter of the pulmonary trunk (OR 0.96, 95% CI 0.89-1.04; P = 0.291), seem to have no relevant influence, whereas Mastora score did (OR 0.99, 95% CI 0.976-0.999, P = 0.045). Subhepatic contrast reflux into IVC is a strong predictor of 24-h and 30-day mortality in patients with acute PE.

Citation

Nikolaos Bailis, Marianne Lerche, Hans Jonas Meyer, Andreas Wienke, Alexey Surov. Contrast reflux into the inferior vena cava on computer tomographic pulmonary angiography is a predictor of 24-hour and 30-day mortality in patients with acute pulmonary embolism. Acta radiologica (Stockholm, Sweden : 1987). 2021 Jan;62(1):34-41