Significance of Right-to-Left Ventricular Ratio as a Quantitative Computed Tomography Biomarker in Patients With Negative Computed Tomography Pulmonary Angiograms.

PURPOSE: The purpose of our study was to determine if the ratio of right-to-left ventricular diameter (RV/LV ratio) on computed tomography (CT) pulmonary angiograms (CTPA) is predictive of 90-day mortality in patients without pulmonary embolism (PE).

MATERIALS AND

METHODS

This Institutional Review Board-approved single-institution retrospective study was performed on patients who underwent CTPA in the emergency or inpatient setting over a 1-year period. Right and left ventricular diameters were measured and RV/LV ratios calculated for patients without acute PE. Ratios greater than or equal to 0.9 were considered abnormal. Univariate analysis was performed for the outcome of death within 90 days of CT. Multivariable analysis was also performed to control for age, sex, and lung disease.

RESULTS

Of the 423 patients included in the study, 55 patients died within 90 days of CT. An RV/LV ratio ≥0.9 was predictive of 90-day mortality: of the 226 patients with RV/LV ≥0.9, 42 (18.6%) died within 90 days, compared with 13 of 197 patients without abnormal ratio (6.6%), with odds ratio (OR) of 3.23 (95% confidence interval [CI]: 1.68-6.22; P<0.01). In multivariate analysis, RV/LV ratio had an OR of 5.19 per unit increase (95%CI: 1.06-25.42; P=0.04); age had an OR of 1.04 per year increase (95% CI: 1.01-1.06; P<0.01).

CONCLUSION

Increased RV/LV ratio is a negative prognostic factor even in patients without acute PE and may be a useful CT biomarker to include in radiology reports for all patients undergoing CTPA.