Comparison of Qanadli Score with Conventional Risk Stratifiers in Non-massive Pulmonary Emboli

Overview

Journal J Int Med Res

Publisher Sage Publications

Specialty General Medicine

Date 2024 Sep 20

PMID 39301817

Authors

Shokoufeh Hajsadeghi

Ali Shamsedini

Pooriya Bahadoran

Erfan Amouei

Shayan Mirshafiee

Affiliations

Soon will be listed here.

Abstract

Objective: The management and risk stratification of non-massive pulmonary embolism (PE) remain unclear. However, early assessment of PE severity can aid physicians in establishing better treatment milestones. There has been no direct comparison of mortality rates in patients with non-massive PE, and existing data are sometimes contradictory. Therefore, we examined the relationship between the Qanadli index and conventional risk stratifiers in PE.

Methods: We retrospectively analyzed 200 consecutively selected patients diagnosed with PE. The assessment included computed tomography pulmonary angiography, electrocardiography, echocardiography findings, outcomes, and a comparison with the Simplified Pulmonary Embolism Severity Index (SPESI) score. Descriptive, regression, and receiver operating characteristic analyses were performed.

Results: The mean Qanadli score was 13.5 ± 1.15. Pearson correlation analysis revealed significant associations between the total Qanadli score and several variables: right ventricular enlargement, follow-up ejection fraction, and SPESI score. Although the Qanadli score did not significantly predict mortality, the risk of death increased by 58.8% for each 1-unit increase in the SPESI score.

Conclusions: Although the Qanadli index is valuable in assessing PE and guiding treatment strategies, its standalone predictive value for mortality may be insufficient. Therefore, incorporating scoring systems such as the SPESI and echocardiographic findings is recommended for more accurate mortality prediction.

References

Konstantinides S, Meyer G, Becattini C, Bueno H, Geersing G, Harjola V . 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2019; 41(4):543-603. DOI: 10.1093/eurheartj/ehz405. View

von Elm E, Altman D, Egger M, Pocock S, Gotzsche P, Vandenbroucke J . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007; 370(9596):1453-7. DOI: 10.1016/S0140-6736(07)61602-X. View

Rodrigues B, Correia H, Figueiredo A, Delgado A, Moreira D, Santos L . [Clot burden score in the evaluation of right ventricular dysfunction in acute pulmonary embolism: quantifying the cause and clarifying the consequences]. Rev Port Cardiol. 2012; 31(11):687-95. DOI: 10.1016/j.repc.2012.02.020. View

Ghuysen A, Ghaye B, Willems V, Lambermont B, Gerard P, Dondelinger R . Computed tomographic pulmonary angiography and prognostic significance in patients with acute pulmonary embolism. Thorax. 2005; 60(11):956-61. PMC: 1747227. DOI: 10.1136/thx.2005.040873. View

Lerche M, Bailis N, Akritidou M, Meyer H, Surov A . Pulmonary Vessel Obstruction Does Not Correlate with Severity of Pulmonary Embolism. J Clin Med. 2019; 8(5). PMC: 6571763. DOI: 10.3390/jcm8050584. View

Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galie N, Pruszczyk P . Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J. 2008; 29(18):2276-315. DOI: 10.1093/eurheartj/ehn310. View

Ten Wolde M, Sohne M, Quak E, Mac Gillavry M, Buller H . Prognostic value of echocardiographically assessed right ventricular dysfunction in patients with pulmonary embolism. Arch Intern Med. 2004; 164(15):1685-9. DOI: 10.1001/archinte.164.15.1685. View

Kumamaru K, Saboo S, Aghayev A, Cai P, Quesada C, George E . CT pulmonary angiography-based scoring system to predict the prognosis of acute pulmonary embolism. J Cardiovasc Comput Tomogr. 2016; 10(6):473-479. DOI: 10.1016/j.jcct.2016.08.007. View

Wells P, Peacock W, Fermann G, Coleman C, Wang L, Baser O . The value of sPESI for risk stratification in patients with pulmonary embolism. J Thromb Thrombolysis. 2019; 48(1):149-157. DOI: 10.1007/s11239-019-01814-z. View

10.

Attina D, Valentino M, Galie N, Modolon C, Buia F, De Luca F . Application of a new pulmonary artery obstruction score in the prognostic evaluation of acute pulmonary embolism: comparison with clinical and haemodynamic parameters. Radiol Med. 2011; 116(2):230-45. DOI: 10.1007/s11547-010-0613-1. View

11.

Carson J, Kelley M, Duff A, Weg J, Fulkerson W, Palevsky H . The clinical course of pulmonary embolism. N Engl J Med. 1992; 326(19):1240-5. DOI: 10.1056/NEJM199205073261902. View

12.

Vedovati M, Germini F, Agnelli G, Becattini C . Prognostic role of embolic burden assessed at computed tomography angiography in patients with acute pulmonary embolism: systematic review and meta-analysis. J Thromb Haemost. 2013; 11(12):2092-102. DOI: 10.1111/jth.12429. View

13.

Praveen Kumar B, Rajasekhar D, Vanajakshamma V . Study of clinical, radiological and echocardiographic features and correlation of Qanadli CT index with RV dysfunction and outcomes in pulmonary embolism. Indian Heart J. 2015; 66(6):629-34. PMC: 4310961. DOI: 10.1016/j.ihj.2014.10.405. View

14.

Bazeed M, Saad A, Sultan A, Ghanem M, Khalil D . Prediction of pulmonary embolism outcome and severity by computed tomography. Acta Radiol. 2010; 51(3):271-6. DOI: 10.3109/02841850903524413. View

15.

Jimenez D, Aujesky D, Moores L, Gomez V, Lobo J, Uresandi F . Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med. 2010; 170(15):1383-9. DOI: 10.1001/archinternmed.2010.199. View

16.

Belohlavek J, Dytrych V, Linhart A . Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. Exp Clin Cardiol. 2013; 18(2):129-38. PMC: 3718593. View

17.

Laporte S, Mismetti P, Decousus H, Uresandi F, Otero R, Lobo J . Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry. Circulation. 2008; 117(13):1711-6. DOI: 10.1161/CIRCULATIONAHA.107.726232. View

18.

van der Meer R, Pattynama P, van Strijen M, van den Berg-Huijsmans A, Hartmann I, Putter H . Right ventricular dysfunction and pulmonary obstruction index at helical CT: prediction of clinical outcome during 3-month follow-up in patients with acute pulmonary embolism. Radiology. 2005; 235(3):798-803. DOI: 10.1148/radiol.2353040593. View

19.

Meinel F, Nance Jr J, Schoepf U, Hoffmann V, Thierfelder K, Costello P . Predictive Value of Computed Tomography in Acute Pulmonary Embolism: Systematic Review and Meta-analysis. Am J Med. 2015; 128(7):747-59.e2. DOI: 10.1016/j.amjmed.2015.01.023. View

20.

Patel P, Patel P, Bhatt M, Braun C, Begum H, Wiercioch W . Systematic review and meta-analysis of test accuracy for the diagnosis of suspected pulmonary embolism. Blood Adv. 2020; 4(18):4296-4311. PMC: 7509887. DOI: 10.1182/bloodadvances.2019001052. View