CTPA in Acute PE Is Highly Sensitive but Not Specific for Detection of RVS

Background: Acute pulmonary embolism (PE) causes a physical obstruction due to the clot in addition to pulmonary vasoconstriction. This increases right ventricular (RV) afterload and, in severe cases, can cause RV dilatation and RV strain (RVS), which can, in turn, progress to RV failure. Since RV failure is the primary cause of death from PE, identification of RVS is very important for risk stratification. Transthoracic echocardiography (TTE) is the reference standard for assessment of RVS, but it is not a first-line evaluation or universally available. CT pulmonary angiography (CTPA) is the imaging modality of choice for the diagnosis of patients with suspected acute PE. CT can also evaluate RV size, and the ratio of RV to left ventricular (LV) size (RV/LV ratio), which can be used as a measure of RVS, although its accuracy is not well established. Objective: To evaluate the accuracy of RVS measurements on CTPA when compared to the reference standard of TTE. Design: Retrospective a more...