Novel method for pulmonary embolism prognosis: Right to left ventricular volume ratio (RLVR) on pulmonary angiography (CTPA)

Right ventricular dysfunction is the main cause of mortality in patients with acute massive pulmonary thromboembolism (PTE) and early diagnosis is extremely important. This study aimed to investigate whether the right/left ventricular volume ratio (RLVR) calculated using pulmonary angiography (CTPA) is a valuable tool for PTE prognosis. Clinical, echocardiographic and pulmonary angiography data of cases diagnosed with pulmonary thromboembolism in the emergency department between January 2021 and December 2023 were retrospectively evaluated. Patients were stratified according to the presence of massive PTE, one month mortality and pulmonary embolism severity index (PESI) score. Clinical, laboratory and radiographic parameters were compared to search for prognostic factors. Of the 210 patients, the mean age was 67±15 years, 46% were male, and 42% had massive PTE. The right/left ventricular volume ratio was significantly higher in patients with massive PTE, in those who died within one month after admission; and patients with PESI Class III. When the cut-off value of right/left ventricular volume ratio was accepted as >1.7, its predictive value for acute pulmonary thromboembolism mortality was higher than other CTPA and echocardioraphy measurements (AUC=0.706). An increased right/left ventricular volume ratio on CTPA, a valuable tool for diagnosing right ventricular dysfunction, is associated with a worse prognosis in subjects with pulmonary thromboembolism. • CT pulmonary angiography (CTPA) can be used to predict PTE prognosis • Right ventricular dysfunction in PTE can be diagnosed by using CTPA • Right to left ventricular volume ratio (RLVR) can be measured in CTPA • The RLVR can be an alternative to echocardiography parameters for massive PTE • The RLVR is a useful predictor for PTE mortality