Abstract

Background: Pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. Computed tomography pulmonary angiography (CTPA) is the diagnostic standard and provides imaging markers of right ventricular dysfunction and clot burden that may aid prognostication. However, evidence on the prognostic value of CTPA-derived parameters in sub-Saharan African populations remains limited.
Methods: In this retrospective cohort study, patients with CTPA-confirmed PE at Kilimanjaro Christian Medical Centre between January 2022 and December 2024 were included. Demographic, clinical, and imaging variables—including right-to-left ventricular (RV/LV) ratio, septal deviation, inferior vena cava (IVC)/hepatic contrast reflux, pulmonary artery diameter, pleural effusion, and Qanadil obstruction index—were collected. The simplified Pulmonary Embolism Severity Index (sPESI) was used for clinical risk stratification. Associations with 30-day mortality and intensive care unit (ICU) admission were analyzed using multivariable regression models.
Results: Fifty patients were analyzed (mean age 58.8 ± 20.2 years, 78% female). Thirty-day mortality was 26%, and 62% required ICU admission. RV/LV ratio ≥1 (72%) and septal deviation (64%) were frequent indicators of right ventricular strain. IVC/hepatic contrast reflux was significantly associated with high-risk sPESI classification and independently predicted ICU admission (adjusted prevalence ratio 2.59, 95% CI: 1.33–5.02). No CTPA-derived parameter independently predicted 30-day mortality after adjustment.
Conclusion: CTPA markers of right ventricular dysfunction correlate with disease severity and ICU requirement but did not independently predict short-term mortality. These findings highlight the complementary role of imaging alongside clinical risk scores in PE risk stratification in resource-limited settings.

Key words: CTPA, PE, Short-Term Outcomes, sPESI, Tanzania