Ay et al identified markers that can help to determine the clinical severity of a pulmonary embolism (PE). These can help to distinguish a patient who may benefit from more aggressive management. The authors are from Hitit University and Antalya Training and Research Hospital in Turkey.
Patient selection: acute pulmonary embolism
Outcome: mild, moderate or severe risk group
Parameters:
(1) right ventricular to left ventricular diameter ratio (RVD/LVD) on PCTA (pulmonary CT angiography)
(2) blood lactate
(3) serum troponin I
Measurement of ventricular diameter on PCTA:
(1) RVD = distance between the septum and the inner wall just below the tricuspid valve
(2) LVD = between the septum and the inner wall just below the mitral valve
Criteria for the high risk group:
(1) blood lactate > 2.3 mmol/L (upper limit of normal 1.3; sensitivity 70%, specificity 90%)
(2) RVD to LVD ratio > 1.4 (sensitivity 71%, specificity 80%)
(3) RVD > 45 mm (sensitivity 77%, specificity 72%)
An elevated serum troponin I was positive in either moderate or high-risk PE.
