Patient selection: acute pulmonary embolism
Outcome: 30-day mortality
Parameters:
(1) position of interventricular septum
(2) contrast reflux into the inferior vena cava (IVC, see 07.13.08)
(3) ratio of the right ventricular axial diameter to left ventricular axial diameter in the 4 chamber view
(4) ratio of the right ventricular volume to left ventricular volume from 3 dimensional volumetric analysis
|
Parameter
|
Finding
|
Points
|
|
position of the interventricular septum
|
convex toward the RV (normal)
|
0
|
|
|
flattened, or septal bowing towards the LV
|
1
|
|
contrast reflux into the IVC
|
Grade 1 to 3
|
0
|
|
|
Grade 4 to 6 (reflux into hepatic veins)
|
1
|
|
RVD to LVD ratio
|
<= 1
|
0
|
|
|
> 1
|
1
|
|
RVV to LVV ratio
|
<= 1.2
|
0
|
|
|
> 1.2
|
1
|
where:
• The axial sections show the maximal distance between the ventricular endocardium and the interventricular septum, perpendicular to the long axis of the heart.
• The hazard ratio was 2 to 2.6 for the first 3 parameters and 6.5 for the fourth. In the implementation the fourth item will be assigned 2 points.
number of factors associated with an adverse outcome =
= SUM(points for all 4 parameters)
Interpretation:
• minimum number of factors: 0
• maximum number of factors: 4
• The risk of mortality increases with the number of risk factors present.
