Written by Megan Hilbert
Spoon Feed
This study identified high sensitivity of RV/LV ratio and high specificity of septal deviation in detecting right ventricular dysfunction (RVD) via CT in acute PE; important as they serve as surrogate markers for poorer outcomes.
Why does this matter?
Pulmonary embolism (PE) is the third most common cause of cardiovascular death in North America. Typical ED work-up includes cardiac biomarkers and advanced CT imaging. But what if your CT could not only identify PE, but give additional (reliable) information regarding morbidity and mortality?
Getting rid of echo?
This article is a systematic review and meta-analysis to assess the diagnostic accuracy of CT in identifying RVD in patients with PE as compared to a comprehensive echo. Their analysis demonstrated that septal deviation had the highest specificity 0.98 (95%CI 0.90-1.00; I2 = 46.9%) and RV/LV ratio had the highest sensitivity 0.83 (95%CI 0.78-0.87; I2 = 81.8%) in identifying RVD. The authors posit that this CT information could negate the need for a comprehensive echo on an inpatient basis – cutting down on hospital costs and preventing delay in interventions, goals that the medical field strives for.
This study and its aims are targeted more toward the inpatient world, making it less applicable to implementation in the ED where I practice. And being honest, this Ultrasound Fellow will always opt for POCUS. Having said that, in the future I will pay more attention to septal deviation and RV/LV ratio not only in my bedside echo, but the CT as well since it can help support my management and ultimate disposition of patients presenting with PE.
Source
Detection of right ventricular dysfunction in acute pulmonary embolism by computed tomography or echocardiography: A systematic review and meta-analysis. J Thromb Haemost. 2021 Jul 10. doi: 10.1111/jth.15453. Online ahead of print.
But how would these findings change management, now that we know that "intermediate risk" PE doesn’t really benefit from thrombolytics?