Multimodality cardiovascular imaging in pulmonary embolism

Abstract

Acute pulmonary embolism (APE) is one of the leading causes of cardiovascular (CV) morbidity and
mortality. To select appropriate therapeutic strategy and/or to minimize the mortality and morbidity,
rapid and correct identification of life-threatening APE is very important. Also, right ventricular (RV)
failure usually precedes acute hemodynamic compromise or death, and thus the identification of RV
failure is another important step in risk stratification or treatment of APE. With advances in diagnosis
and treatment, the prognosis of APE has been dramatically improving in most cases, but inadequate
therapy or recurrent episodes of pulmonary embolism (PE) may result in negative outcomes or, so called,
chronic thromboembolic pulmonary hypertension (CTEPH). CTEPH is a condition characterized by
remaining chronic thromboembolic material in the pulmonary vasculature and subsequent chronic
pulmonary hypertension.
Various imaging modalities include chest computed tomography pulmonary angiography (CTPA),
echocardiography, magnetic resonance imaging, and nuclear imaging and each are used for the assessment
of varying status of PE. Assessment of thromboembolic burden by chest CTPA is the first step in
the diagnosis of PE. Hemodynamic assessment can be achieved by echocardiography and also by chest
CTPA. Nuclear imaging is useful in discriminating CTEPH from APE.
Better perspectives on diagnosis, risk stratification and decision making in PE can be provided by
combining multimodality CV imaging. Here, the advantages or pitfalls of each imaging modality in
diagnosis, risk stratification, or management of PE will be discussed.