Vienalaikės širdies ir plaučių kompiuterinės tomografijos angiografijos metodo taikymas ir vertinimas nustatant plaučių arterijos trombinę emboliją

Pulmonary arterial thromboembolism (PATE) is the third most common acute cardiovascular disease after myocardial infarction and stroke. Frequently individual symptoms are nonspecific making clinical diagnosis of acute PATE difficult. Computed tomographic (CT) pulmonary angiography has become the first line examination performed in patients with suspected acute PATE. Severity of acute PATE directs treatment strategies and allows prognostication of outcomes. It is reported that patients with normal blood pressure and impaired RV function have a larger average PATE-related short-term mortality compared to patients with normal RV function. Cardiopulmonary CT with retrospective electrocardiographic synchronization allows simultaneous evaluation of pulmonary arterial bed, cardiac function, coronary arteries and thoracic aorta. We have used cardiopulmonary CT to detect right and left ventricular changes in the setting of acute PATE, to describe relationship between reduced right ventricular function and pulmonary arterial thromboembolic burden and to find best predictors of markedly reduced right ventricular ejection fraction. Reproducibility of right ventricular measurements in cardiopulmonary CT images and quality analysis of cardiopulmonary CT for evaluation of coronary arteries and thoracic aorta were done. Results of the study show that both the right and left ventricles develop detectable changes in acute PATE patients, the decrease of the right ventricular ejection fraction is proportional to a pulmonary arterial thromboembolic burden, right and left ventricular end diastolic volume ratio is a best predictor of markedly reduced right ventricular ejection fraction in patients with acute PATE. In most patients without acute PATE quality of cardiopulmonary CT is sufficient for the evaluation of coronary arteries and thoracic aorta