Vol. 6, Issue 1, Part A (2024)

Background: Pulmonary thromboembolism (PTE) stands as a prominent etiological factor in cardiovascular fatalities, wherein dysfunction within the right ventricular region (RVD) serves as a pivotal prognostic determinant of deleterious consequences. The CHA2DS2-VASc and Pulmonary Embolism Severity Index (PESI) scores are established tools in the risk stratification of thromboembolic events, but their association with RVD in PTE patients remains to be elucidated. This investigation sought to elucidate the relationships between the CHA2DS2-VASc and PESI scores, examining each of their respective links to RV dysfunction as delineated through CTPA.
Materials and Methods: This cross-sectional, comparative, multi-center study included 145 patients with acute PTE diagnosed by CTPA. Patients were categorized into two groups based on the presence (Group 1, n=107) or absence (Group 2, n=38) of RVD. The quantification of the CHA2DS2-VASc and PESI indices was executed, subsequent to which their interrelations with RVD were meticulously analyzed utilizing logistic regression techniques, complemented by an examination via ROC curve analytics.
Results: Patients with RV dysfunction had statistically significantly higher mean CHA2DS2-VASc & PESI scores (3.69±1.32 vs. 3.01±1.14 & 128.37±15.33 vs. 102.47±54.12; respectively with P = 0.001). Also, our study showed that both CHA2DS2-VASc score, and PESI score had significant positive correlation. CHA2DS2-VASc score at cut off value >3 and PESI score at cut off value >95 were independent predictors of RV dysfunction in acute PE patients. ROC curve analysis demonstrated that AUC for CHA2DS2-VASc score was higher than that of PESI score (AUC=0.89 vs. 0.63).
Conclusion: In patients with acute PE, the CHA2DS2-VASc and PESI scores are independent predictors of right ventricular dysfunction. These easily calculated scores can be used for risk stratification, identifying high-risk patients who require more comprehensive treatment and follow-up.