An Analogy Between Clot Burden and Right Ventricular Dysfunction in Acute Pulmonary Thromboembolism on Computed Tomography Pulmonary Angiography Using Modified Millers Score: A One Year Hospital Based Cross Sectional Study

Acute pulmonary thromboembolism (PTE) is a critical cardiovascular condition with high mortality, especially when associated with right ventricular dysfunction (RVD). Computed tomography pulmonary angiography (CTPA) is the standard diagnostic tool for PTE, assessing thrombus burden and RVD indicators.This study aimed to determine the correlation between pulmonary embolism thrombus load, assessed using the Modified Miller Score (MMS), and RVD as demonstrated by CTPA. Additionally, it explored the relationship between thrombus load, CT signs, and 2D echocardiographic features of RVD.A prospective, hospital-based study was conducted over one year at Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi, involving 49 PTE patients undergoing CTPA and transthoracic echocardiography. CTPA scans were evaluated for PTE severity using MMS and RVD features.A significant association was observed between higher clot burden (MMS ≥13) and RVD markers. Patients with MMS ≥13 exhibited a positive RV/LV ratio in 69.39% (p = 0.0002), septal deviation in 30.61% (p = 0.0012), and a positive MPA/AA ratio in 65.31% (p = 0.0025). RA/RV enlargement was noted in 48.98% (p < 0.0001), PASP was elevated in 40.82% (p < 0.0001), and TAPSE was significantly lower (p < 0.0001).MMS >13 strongly correlated with RVD on CTPA (p < 0.01) and may serve as a predictor of RVD, facilitating faster diagnosis of PTE and right heart strain using CTPA alone.