Lisette van Dam

Chapter 10 156 combination with D-dimer testing, following the YEARS algorithm. 12,13 In patients with CTPA-confirmed acute PE, anticoagulant treatment was started or modified in patients already on anticoagulant treatment according to international standards. The Hestia rule, consisting of 11 clinical criteria, was used to identify low risk PE patients for outpatient treatment. 11,14,15 This study was approved by the institutional review board of the LUMC, and informed consent requirement was waived due to its observational nature. Primary and secondary aim The primary aim was to investigate the correlation between quantification of CTPP-measured perfusion defects with clinical symptoms at presentation, and its predictive value for adverse short-term 7-day outcome. The secondary aim was to investigate the added value of CTPP reading to right ventricle to left ventricle diameter ratio (RV/LV ratio), pulmonary artery trunk diameter and total thrombus load on CTPA for prediction of intensive care unit (ICU) admission, reperfusion therapy and PE-related mortality. Furthermore, the correlation between perfusion defect score on CTPP and total thrombus load on CTPA was evaluated. Outcomes For the primary outcome, clinical symptoms at presentation and adverse short- term outcome were evaluated. Clinical symptoms included (non-)pleural chest pain, dyspnoea and haemoptysis. Adverse short-term outcome included hospital or ICU admission, need for supplemental oxygen therapy or intravenous pain medication > 24 hours, reperfusion therapy, vasopressor or inotropic therapy and PE-related death within 7-day follow-up. All symptoms and outcomes were assessed from digital patient files. For the secondary outcome, we assessed prognostic imaging signs on CTPA including RV/LV ratio, pulmonary artery trunk diameter and total thrombus load. The predictive capacity of these CTPA clinical imaging signs and of PDS for the outcome of ICU admission, reperfusion therapy and PE-related mortality was evaluated.