Sex differences in the prognostic value of computed tomography pulmonary angiography parameters for intrahospital acute pulmonary embolism-related death

Jelena Bošković Sekulić; Igor  Sekulić; Boris Džudović; Bojana Subotić; Sonja Salinger; Jovan Matijašević; Tamara Kovačević; Irena Mitevska; Vladimir  Miloradović; Aleksandar Nešković; Slobodan Obradović

doi:10.2298/VSP240109023B

Jelena Bošković Sekulić University Clinical Center Kragujevac, Clinic of Emergency Medicine, Kragujevac, Serbia
Igor Sekulić University Clinical Center Kragujevac, Institute for Radiology, Belgrade, Serbia University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia;
Boris Džudović Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Bojana Subotić Military Medical Academy, Clinic for Cardiology, Belgrade, Serbia
Sonja Salinger University Clinical Center Niš, Clinic of Cardiology, Niš, Serbia; University of Niš, Faculty of Medicine, Niš , Serbia
Jovan Matijašević Institute of Pulmonary Diseases Vojvodina, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Tamara Kovačević Clinical Center Banja Luka, Clinic of Cardiology, Banja Luka, Republic of Srpska, Bosnia and Herzegovina; University of Banja Luka, Faculty of Medicine, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
Irena Mitevska University Cardiology Clinic, Intensive Care Unit, Skopje, North Macedonia
Vladimir Miloradović University Clinical Center Kragujevac, Clinic of Cardiology, Kragujevac, Serbia; University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
Aleksandar Nešković University Clinical Hospital Center Zemun, Clinic of Cardiology, Belgrade , Serbia University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Slobodan Obradović Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP240109023B

Keywords: computed tomography angiography;, mortality;, multidetector computed tomography;, pulmonary embolism;, sex;, treatment outcome

Abstract

Background/Aim. Multidetector computed tomography pulmonary angiography (MCTPA) has emerged as the most suitable method for diagnosing acute pulmonary embolism (APE) in hemodynamically stable patients. In addition to its diagnostic role, MCTPA facilitates the measurement and calculation of certain parameters that can be used as prognostic markers for outcomes in APE. Since the introduction of the method, there have been a lot of studies that pointed out there may be a significant difference in the prognostic value of MCTPA for APE concerning sex. Methods. The study population consisted of consecutive patients with a diagnosis of APE confirmed by MCTPA. Positive MCTPA findings and a diagnosis of APE were established if the patient had at least one segmental artery thrombus. APE severity was estimated using the simplified Pulmonary Embolism Severity Index (sPESI). All-cause and APE-related intrahospital deaths were the coprimary outcomes of this study. Results. In total, 1,612 patients were enrolled in the study (750 men and 862 women). Women with a centrally positioned pulmonary thrombus detected on MCTPA were more likely to die from PE-related death than those without one (10.4% vs. 4.2%, respectively; p = 0.016). Women with a right ventricle (RV) and left ventricle (LV) diameter ratio (RV/LV) > 1 died almost twice as often as those with a ratio ≤ 1 (15.5% vs. 8.6%, respectively; p = 0.017). Women with an RV/LV > 1 detected with MCTPA were significantly more likely to die from PE than those with a ratio ≤ 1 (11% vs. 5.2%, respectively; p = 0.017). Women who died from PE-related causes had a significantly higher value of the embolic burden score system (EBSS) than did the surviving women (18.00 vs. 11.00, respectively; p = 0.025). Independently of age, sPESI, and renal function, the presence of a central thrombus [odds ratio (OR) 2.278, 95% confidence interval (CI): 1.050–4.944, p = 0.037] and the RV/LV ratio > 1 (OR 2.015, 95% CI: 1.042–3.893, p = 0.037) were associated with intrahospital PE-related death in women. Conclusion. In women, MCTPA parameters, a centrally placed thrombus, the RV/LV ratio, and the EBSS had prognostic significance for PE-related mortality. The RV/LV ratio had prognostic significance for all-cause intrahospital mortality. In men, the MCTPA parameters had no prognostic significance for both overall and PE-related mortality.

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