The Prognostic Value of Descending Aorta to Main Pulmonary Artery Enhancement Ratio in Massive or Sub-Massive Acute Pulmonary Embolism

Background: Pulmonary embolism (PE) is a potentially lethal condition if left untreated. There have been many efforts to find prognostic factors in patients with PE. The descending aorta enhancement (DAE) to main pulmonary artery enhancement (MPAE) ratio is a rather new imaging finding that has been suggested for prognostic purposes in such patients. Objectives: To examine the prognostic value of DAE/MPAE in massive/submassive PE. Patients and Methods: A total of 47 patients with massive/submassive acute PE and compromised right ventricular function were studied prospectively. The Hounsfield units of DAE and MPAE were obtained on pulmonary computed tomography angiography (PCTA). The DAE/MPAE ratio was compared between two groups of patients with and without in-hospital major adverse event/30-day mortality. Results: Twenty-four patients (51.1%) were hemodynamically unstable at the time of admission. Endotracheal intubation and cardiopulmonary resuscitation were indicated in 27.7% (n = 13) and 10.6% (n = 5) of patients, respectively. The rate of PE-unrelated adverse events or mortality was 10.6%. High correlations were present between observers in terms of reported DAE and MPAE (intraclass correlation coefficient = 0.99 for both). No significant association was found between DAE/MPAE and the occurrence of PE-related or unrelated in-hospital major adverse event or 30-day mortality. A significant reverse correlation was observed between DAE/MPAE and patients’ age (Pearson r = -0.47, P = 0.001). Conclusion: DAE/MPAE measured on PCTA may not predict PE-related or PE-unrelated poor outcome in patients with massive or submassive pulmonary embolism.