Patent foramen ovale in patients with pulmonary embolism: A prognostic factor on CT pulmonary angiography?

Meng Zhang, Stephanie Tan, Vishal Patel, Amin B. Zalta, Anna Shmukler, Jeffrey M. Levsky, Vineet R. Jain, Nada M. Shaban, Linda B. Haramati

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Patent foramen ovale (PFO) in patients with acute pulmonary embolism (PE) represents a risk factor for mortality, but this has not been evaluated for CT pulmonary angiography (CTPA). The purpose of the present study was to assess the relationship between PFO and mortality in patients with acute PE diagnosed on CTPA. Materials and methods: This retrospective study included 268 adults [173 women, mean age 61 (range 22-98) years] diagnosed with acute PE on non-ECG-gated 64-slice CTPA in 2012 at our medical center. The images were reviewed for PFO by a panel of cardiothoracic radiologists with an average of 11 years of experience (range 1-25 years). CT signs of right heart strain and PE level were noted. Transthoracic echocardiograms (TTE), when available (n = 207), were reviewed for PFO by a cardiologist with subspecialty training in advanced imaging and with 3 years of experience. The main outcome was 30-day mortality. Fischer's exact test was utilized to compare mortality. Results: PFO prevalence on CTPA was 22% (58/268) and 4% (9/207) on TTE. Overall 30-day mortality was 6% (16/268), 9% (5/58) for patients with PFO and 5% (11/210) for those without (p = 0.35). CT signs of right heart strain trended with higher mortality, but statistically significant only for hepatic vein contrast reflux [14% (6/44) vs 4% (10/224), p = 0.03]; right ventricular (RV) to left ventricular (LV) diameter ratio >1 [8% (13/156) vs RV:LV ≤ 1 3% (3/112), p = 0.07], septal bowing [10% (4/42) vs without 5% (12/226), p = 0.30]. Conclusion: PFO was demonstrated on CTPA in a proportion similar to the known population prevalence, while routine TTE was less sensitive. Mortality was non-significantly higher in patients with acute PE and PFO in this moderate-sized study. A larger study to answer this clinically important question is worthwhile.

Original languageEnglish (US)
JournalJournal of Cardiovascular Computed Tomography
DOIs
StateAccepted/In press - Jan 1 2017

Fingerprint

Patent Foramen Ovale
Pulmonary Embolism
Lung
Mortality
Hepatic Veins
Computed Tomography Angiography
Retrospective Studies

Keywords

  • CT pulmonary angiogram
  • Mortality
  • Patent foramen ovale
  • Pulmonary embolism
  • Transthoracic echocardiogram

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{f1e9b842d7524698854a5f0f64227936,
title = "Patent foramen ovale in patients with pulmonary embolism: A prognostic factor on CT pulmonary angiography?",
abstract = "Background: Patent foramen ovale (PFO) in patients with acute pulmonary embolism (PE) represents a risk factor for mortality, but this has not been evaluated for CT pulmonary angiography (CTPA). The purpose of the present study was to assess the relationship between PFO and mortality in patients with acute PE diagnosed on CTPA. Materials and methods: This retrospective study included 268 adults [173 women, mean age 61 (range 22-98) years] diagnosed with acute PE on non-ECG-gated 64-slice CTPA in 2012 at our medical center. The images were reviewed for PFO by a panel of cardiothoracic radiologists with an average of 11 years of experience (range 1-25 years). CT signs of right heart strain and PE level were noted. Transthoracic echocardiograms (TTE), when available (n = 207), were reviewed for PFO by a cardiologist with subspecialty training in advanced imaging and with 3 years of experience. The main outcome was 30-day mortality. Fischer's exact test was utilized to compare mortality. Results: PFO prevalence on CTPA was 22{\%} (58/268) and 4{\%} (9/207) on TTE. Overall 30-day mortality was 6{\%} (16/268), 9{\%} (5/58) for patients with PFO and 5{\%} (11/210) for those without (p = 0.35). CT signs of right heart strain trended with higher mortality, but statistically significant only for hepatic vein contrast reflux [14{\%} (6/44) vs 4{\%} (10/224), p = 0.03]; right ventricular (RV) to left ventricular (LV) diameter ratio >1 [8{\%} (13/156) vs RV:LV ≤ 1 3{\%} (3/112), p = 0.07], septal bowing [10{\%} (4/42) vs without 5{\%} (12/226), p = 0.30]. Conclusion: PFO was demonstrated on CTPA in a proportion similar to the known population prevalence, while routine TTE was less sensitive. Mortality was non-significantly higher in patients with acute PE and PFO in this moderate-sized study. A larger study to answer this clinically important question is worthwhile.",
keywords = "CT pulmonary angiogram, Mortality, Patent foramen ovale, Pulmonary embolism, Transthoracic echocardiogram",
author = "Meng Zhang and Stephanie Tan and Vishal Patel and Zalta, {Amin B.} and Anna Shmukler and Levsky, {Jeffrey M.} and Jain, {Vineet R.} and Shaban, {Nada M.} and Haramati, {Linda B.}",
year = "2017",
month = "1",
day = "1",
doi = "10.1016/j.jcct.2017.11.009",
language = "English (US)",
journal = "Journal of Cardiovascular Computed Tomography",
issn = "1934-5925",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Patent foramen ovale in patients with pulmonary embolism

T2 - A prognostic factor on CT pulmonary angiography?

AU - Zhang, Meng

AU - Tan, Stephanie

AU - Patel, Vishal

AU - Zalta, Amin B.

AU - Shmukler, Anna

AU - Levsky, Jeffrey M.

AU - Jain, Vineet R.

AU - Shaban, Nada M.

AU - Haramati, Linda B.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background: Patent foramen ovale (PFO) in patients with acute pulmonary embolism (PE) represents a risk factor for mortality, but this has not been evaluated for CT pulmonary angiography (CTPA). The purpose of the present study was to assess the relationship between PFO and mortality in patients with acute PE diagnosed on CTPA. Materials and methods: This retrospective study included 268 adults [173 women, mean age 61 (range 22-98) years] diagnosed with acute PE on non-ECG-gated 64-slice CTPA in 2012 at our medical center. The images were reviewed for PFO by a panel of cardiothoracic radiologists with an average of 11 years of experience (range 1-25 years). CT signs of right heart strain and PE level were noted. Transthoracic echocardiograms (TTE), when available (n = 207), were reviewed for PFO by a cardiologist with subspecialty training in advanced imaging and with 3 years of experience. The main outcome was 30-day mortality. Fischer's exact test was utilized to compare mortality. Results: PFO prevalence on CTPA was 22% (58/268) and 4% (9/207) on TTE. Overall 30-day mortality was 6% (16/268), 9% (5/58) for patients with PFO and 5% (11/210) for those without (p = 0.35). CT signs of right heart strain trended with higher mortality, but statistically significant only for hepatic vein contrast reflux [14% (6/44) vs 4% (10/224), p = 0.03]; right ventricular (RV) to left ventricular (LV) diameter ratio >1 [8% (13/156) vs RV:LV ≤ 1 3% (3/112), p = 0.07], septal bowing [10% (4/42) vs without 5% (12/226), p = 0.30]. Conclusion: PFO was demonstrated on CTPA in a proportion similar to the known population prevalence, while routine TTE was less sensitive. Mortality was non-significantly higher in patients with acute PE and PFO in this moderate-sized study. A larger study to answer this clinically important question is worthwhile.

AB - Background: Patent foramen ovale (PFO) in patients with acute pulmonary embolism (PE) represents a risk factor for mortality, but this has not been evaluated for CT pulmonary angiography (CTPA). The purpose of the present study was to assess the relationship between PFO and mortality in patients with acute PE diagnosed on CTPA. Materials and methods: This retrospective study included 268 adults [173 women, mean age 61 (range 22-98) years] diagnosed with acute PE on non-ECG-gated 64-slice CTPA in 2012 at our medical center. The images were reviewed for PFO by a panel of cardiothoracic radiologists with an average of 11 years of experience (range 1-25 years). CT signs of right heart strain and PE level were noted. Transthoracic echocardiograms (TTE), when available (n = 207), were reviewed for PFO by a cardiologist with subspecialty training in advanced imaging and with 3 years of experience. The main outcome was 30-day mortality. Fischer's exact test was utilized to compare mortality. Results: PFO prevalence on CTPA was 22% (58/268) and 4% (9/207) on TTE. Overall 30-day mortality was 6% (16/268), 9% (5/58) for patients with PFO and 5% (11/210) for those without (p = 0.35). CT signs of right heart strain trended with higher mortality, but statistically significant only for hepatic vein contrast reflux [14% (6/44) vs 4% (10/224), p = 0.03]; right ventricular (RV) to left ventricular (LV) diameter ratio >1 [8% (13/156) vs RV:LV ≤ 1 3% (3/112), p = 0.07], septal bowing [10% (4/42) vs without 5% (12/226), p = 0.30]. Conclusion: PFO was demonstrated on CTPA in a proportion similar to the known population prevalence, while routine TTE was less sensitive. Mortality was non-significantly higher in patients with acute PE and PFO in this moderate-sized study. A larger study to answer this clinically important question is worthwhile.

KW - CT pulmonary angiogram

KW - Mortality

KW - Patent foramen ovale

KW - Pulmonary embolism

KW - Transthoracic echocardiogram

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DO - 10.1016/j.jcct.2017.11.009

M3 - Article

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JO - Journal of Cardiovascular Computed Tomography

JF - Journal of Cardiovascular Computed Tomography

SN - 1934-5925

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