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Radiological Cardiothoracic Ratio as a Potential Predictor of Right Ventricular Enlargement in Patients with Suspected Pulmonary Embolism Due to COVID-19

The aim of the study was to determine the usefulness of the radiological cardiothoracic ratio (CTR) as a predictor of right ventricular enlargement in patients with suspected pulmonary embolism during COVID-19. The study group consisted of 61 patients with confirmed COVID-19, suspected of pulmonary...

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Autores principales: Truszkiewicz, Krystian, Poręba, Małgorzata, Poręba, Rafał, Gać, Paweł
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658615/
https://www.ncbi.nlm.nih.gov/pubmed/34884405
http://dx.doi.org/10.3390/jcm10235703
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author Truszkiewicz, Krystian
Poręba, Małgorzata
Poręba, Rafał
Gać, Paweł
author_facet Truszkiewicz, Krystian
Poręba, Małgorzata
Poręba, Rafał
Gać, Paweł
author_sort Truszkiewicz, Krystian
collection PubMed
description The aim of the study was to determine the usefulness of the radiological cardiothoracic ratio (CTR) as a predictor of right ventricular enlargement in patients with suspected pulmonary embolism during COVID-19. The study group consisted of 61 patients with confirmed COVID-19, suspected of pulmonary embolism based on physical examination and laboratory tests (age: 67.18 ± 12.47 years). Computed tomography angiography (CTA) of pulmonary arteries and chest radiograph in AP projection with cardiothoracic ratio assessment were performed in all patients. Right ventricular enlargement was diagnosed by the ratio of right ventricular to left ventricular (RV/LV) dimensions in pulmonary CTA with two cut-off points: ≥0.9 and ≥1.0. Heart silhouette enlargement was found when CTR on the chest radiograph in the projection AP > 0.55. The mean values of RV/LV and CTR in the studied group were 0.96 ± 0.23 and 0.57 ± 0.05, respectively. Pulmonary embolism was diagnosed in 45.9%. Right ventricular enlargement was documented in 44.3% or 29.5% depending on the adopted criterion RV/LV ≥ 0.9 or RV/LV ≥ 1.0. Heart silhouette enlargement was found in 60.6%. Patients with confirmed pulmonary embolism (PE+) had a significantly higher RV/LV ratio and CTR than patients with excluded pulmonary embolism (PE−) (RV/LV: PE+ 1.08 ± 0.24, PE− 0.82 ± 0.12; CTR: PE+ 0.60 ± 0.05, PE− 0.54 ± 0.04; p < 0.05). The correlation analysis showed a statistically significant positive correlation between the RV/LV ratio and CTR (r = 0.59, p < 0.05). Based on the ROC curves, CTR values were determined as the optimal cut-off points for the prediction of right ventricular enlargement (RV/LV ≥ 0.9 or RV/LV ≥ 1.0), being 0.54 and 0.55, respectively. The sensitivity, specificity, and accuracy of the CTR criterion >0.54 as a predictor of RV/LV ratio ≥0.9 were 0.412, 0.963, and 0.656, respectively, while those of the CTR criterion >0.55 as a predictor of RV/LV ratio ≥1.0 were 0.488, 0.833, and 0.590, respectively. In summary, in patients with suspected pulmonary embolism during COVID-19, the radiographic cardiothoracic ratio can be considered as a prognostic factor for right ventricular enlargement, especially as a negative predictor of right ventricular enlargement in the case of lower CTR values.
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spelling pubmed-86586152021-12-10 Radiological Cardiothoracic Ratio as a Potential Predictor of Right Ventricular Enlargement in Patients with Suspected Pulmonary Embolism Due to COVID-19 Truszkiewicz, Krystian Poręba, Małgorzata Poręba, Rafał Gać, Paweł J Clin Med Article The aim of the study was to determine the usefulness of the radiological cardiothoracic ratio (CTR) as a predictor of right ventricular enlargement in patients with suspected pulmonary embolism during COVID-19. The study group consisted of 61 patients with confirmed COVID-19, suspected of pulmonary embolism based on physical examination and laboratory tests (age: 67.18 ± 12.47 years). Computed tomography angiography (CTA) of pulmonary arteries and chest radiograph in AP projection with cardiothoracic ratio assessment were performed in all patients. Right ventricular enlargement was diagnosed by the ratio of right ventricular to left ventricular (RV/LV) dimensions in pulmonary CTA with two cut-off points: ≥0.9 and ≥1.0. Heart silhouette enlargement was found when CTR on the chest radiograph in the projection AP > 0.55. The mean values of RV/LV and CTR in the studied group were 0.96 ± 0.23 and 0.57 ± 0.05, respectively. Pulmonary embolism was diagnosed in 45.9%. Right ventricular enlargement was documented in 44.3% or 29.5% depending on the adopted criterion RV/LV ≥ 0.9 or RV/LV ≥ 1.0. Heart silhouette enlargement was found in 60.6%. Patients with confirmed pulmonary embolism (PE+) had a significantly higher RV/LV ratio and CTR than patients with excluded pulmonary embolism (PE−) (RV/LV: PE+ 1.08 ± 0.24, PE− 0.82 ± 0.12; CTR: PE+ 0.60 ± 0.05, PE− 0.54 ± 0.04; p < 0.05). The correlation analysis showed a statistically significant positive correlation between the RV/LV ratio and CTR (r = 0.59, p < 0.05). Based on the ROC curves, CTR values were determined as the optimal cut-off points for the prediction of right ventricular enlargement (RV/LV ≥ 0.9 or RV/LV ≥ 1.0), being 0.54 and 0.55, respectively. The sensitivity, specificity, and accuracy of the CTR criterion >0.54 as a predictor of RV/LV ratio ≥0.9 were 0.412, 0.963, and 0.656, respectively, while those of the CTR criterion >0.55 as a predictor of RV/LV ratio ≥1.0 were 0.488, 0.833, and 0.590, respectively. In summary, in patients with suspected pulmonary embolism during COVID-19, the radiographic cardiothoracic ratio can be considered as a prognostic factor for right ventricular enlargement, especially as a negative predictor of right ventricular enlargement in the case of lower CTR values. MDPI 2021-12-04 /pmc/articles/PMC8658615/ /pubmed/34884405 http://dx.doi.org/10.3390/jcm10235703 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Truszkiewicz, Krystian
Poręba, Małgorzata
Poręba, Rafał
Gać, Paweł
Radiological Cardiothoracic Ratio as a Potential Predictor of Right Ventricular Enlargement in Patients with Suspected Pulmonary Embolism Due to COVID-19
title Radiological Cardiothoracic Ratio as a Potential Predictor of Right Ventricular Enlargement in Patients with Suspected Pulmonary Embolism Due to COVID-19
title_full Radiological Cardiothoracic Ratio as a Potential Predictor of Right Ventricular Enlargement in Patients with Suspected Pulmonary Embolism Due to COVID-19
title_fullStr Radiological Cardiothoracic Ratio as a Potential Predictor of Right Ventricular Enlargement in Patients with Suspected Pulmonary Embolism Due to COVID-19
title_full_unstemmed Radiological Cardiothoracic Ratio as a Potential Predictor of Right Ventricular Enlargement in Patients with Suspected Pulmonary Embolism Due to COVID-19
title_short Radiological Cardiothoracic Ratio as a Potential Predictor of Right Ventricular Enlargement in Patients with Suspected Pulmonary Embolism Due to COVID-19
title_sort radiological cardiothoracic ratio as a potential predictor of right ventricular enlargement in patients with suspected pulmonary embolism due to covid-19
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658615/
https://www.ncbi.nlm.nih.gov/pubmed/34884405
http://dx.doi.org/10.3390/jcm10235703
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