CT PULMONARY ANGIOGRAPHY IN ACUTE PULMONARY EMBOLISM: THE IMPACT OF CONCOMITANT DEEP VEIN THROMBOSIS ON THE IMAGING BIOMARKERS OF RIGHT HEART STRAIN

Objective: To assess the influence of concomitant deep vein thrombosis (DVT) on CT pulmonary angiography (CTPA) markers of right heart strain (RHS) in patients with acute pulmonary embolism (APE). Material and Methods: A retrospective analysis was conducted on 119 patients diagnosed with APE using CTPA. Key imaging parameters evaluated included the pulmonary artery obstruction index (PAOI), diameters of the right and left atria and ventricles, pulmonary artery (PA) and aorta (Ao), the RV/LV and RA/LA diameter ratios, interventricular septal (IVS) deviation, and inferior vena cava (IVC) contrast reflux. Patients were stratified based on the presence of DVT confirmed by clinical symptoms or ultrasound. Results: DVT was identified in 49 of 119 patients (41.2%). Compared to those without DVT, this group demonstrated significantly elevated PAOI values (61.5 ± 29.2 vs. 49.3 ± 26.3; p = 0.023), larger RA/LA diameter ratios (1.44 ± 0.44 vs. 1.25 ± 0.42; p = 0.016), and higher RV/LV ratios (1.49 ± 0.53 vs. 1.24 ± 0.46; p = 0.017). While PA/Ao ratios and IVC diameters were numerically greater in the DVT group, differences were not statistically significant. IVS shift and IVC contrast reflux were more frequently observed in the DVT subgroup (53.1% and 69.4%, respectively), although without statistical significance (p > 0.5). Conclusions: The presence of DVT in patients with acute PE is associated with more pronounced CTPA markers of right heart strain, particularly elevated PAOI and increased ventricular and atrial diameter ratios. These findings suggest a greater hemodynamic burden in PE patients with concomitant DVT.