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Ventilation/perfusion (V/Q) scanning in contemporary patients with pulmonary embolism: utilization rates and predictors of use in a multinational study

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Abstract

Ventilation/perfusion (V/Q) imaging and computed tomography pulmonary angiography (CTPA) are common tools for acute pulmonary embolism (PE) diagnosis. Limited contemporary data exist about the utilization of each modality, including the predictors of using V/Q versus CTPA. We used the data from patients diagnosed with PE using V/Q or CTPA from 2007 to 2019 in Registro Informatizado Enfermedad ThromboEmbolica, an international prospective registry of patients with venous thromboembolism. Outcomes was to determine the trends in utilization of V/Q vs. CTPA and, in a contemporary subgroup fitting with current practices, to evaluate predictors of V/Q use with multivariable logistic regression. Among 26,540 patients with PE, 89.2% were diagnosed with CTPA, 7.1% with V/Q and 3.7% with > 1 thoracic imaging modality. Over time, the proportional use of V/Q scanning declined (13.9 to 3.3%, P < 0.001). In multivariable analysis, heart failure history (odds ratio [OR]:1.5; 95% confidence interval [CI] 1.14–1.98), diabetes ([OR 1.71; 95% CI 1.39–2.10]), moderate and severe renal failure (respectively [OR 1.87; 95% CI 1.47–2.38] and [OR 9.36; 95% CI 6.98–12.55]) were the patient-level predictors of V/Q utilization. We also observed an influence of geographical and institutional factors, partly explained by time-limited V/Q availability (less use over weekends) and regional practices. Use of V/Q for the diagnosis of PE decreased over time, but it still has an important role in specific situations with an influence of patient-related, institution-related and logistical factors. Local and regional resources should be evaluated to improve V/Q accessibility than could benefit for this population.

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Abbreviations

CI:

Confidence interval

CRI:

Chronic renal insufficiency

CrCl:

Creatinine clearance

CTPA:

Computed tomography pulmonary angiography

CT:

Computed tomography

ESC:

European society of cardiology

pDVT:

Proximal deep venous thrombosis

OR:

Odds ratio

PE:

Pulmonary embolism

PIOPED:

Prospective investigation of pulmonary embolism diagnosis

Sat O2:

Oxygen saturation

SBP:

Systolic blood pressure

SPECT:

Single photon emission computed tomography

VTE:

Venous thrombo-embolism

V/Q:

Ventilation/perfusion

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Acknowledgements

We express our gratitude to Sanofi Spain for supporting this Registry with an unrestricted educational grant. We also thank the RIETE Registry Coordinating Center, S&H Medical Science Service, for their quality control data, logistic and administrative support and Prof. Salvador Ortiz, Universidad Autónoma Madrid and Silvia Galindo, both Statistical Advisors in S&H Medical Science Service for the statistical analysis of the data presented in this paper.

Funding

No funding for this study.

Author information

Authors and Affiliations

  1. Service de Médecine Nucléaire, CHU de Saint-Etienne, 42055, Saint-Étienne, France

    Pierre-Benoît Bonnefoy, Nathalie Prevot & Alicia Sanchez

  2. INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, 42055, Saint-Etienne, France

    Nathalie Prevot & Laurent Bertoletti

  3. Department of Medicine, Peconic Bay Medical Center, Northwell Health, Riverhead, NY, USA

    Ghazaleh Mehdipoor & Behnood Bikdeli

  4. Cardiovascular Research Foundation (CRF), New York, NY, USA

    Ghazaleh Mehdipoor

  5. Department of Pneumonology, Hospital Universitario de Valme, Sevilla, Spain

    Jorge Lima

  6. Department of Haematology, Hospital de Tortosa Verge de La Cinta, Tarragona, Spain

    Llorenç Font

  7. Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, Spain

    Aída Gil-Díaz

  8. Department of Haematology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain

    Pilar Llamas

  9. Department of Internal Medicine, Hospital Clínic, Barcelona, Barcelona, Spain

    Jesús Aibar

  10. Cardiovascular Medicine Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Behnood Bikdeli

  11. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, USA

    Behnood Bikdeli

  12. Service de Médecine Vasculaire Et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France

    Laurent Bertoletti

  13. INSERM, CIC-1408, CHU Saint-Etienne, 42055, Saint-Etienne, France

    Laurent Bertoletti

  14. F-CRIN INNOVTE Network, Saint-Etienne, France

    Laurent Bertoletti

  15. Department of Internal Medicine, Hospital Universitari Germans Trias I PujolBadalona, Barcelona, Universidad Católica de Murcia, Barcelona, Spain

    Manuel Monreal

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  1. Pierre-Benoît Bonnefoy
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And RIETE investigators

Contributions

PBB substantially contributed to the conception and design of the work, write the manuscript, approved the final version of the manuscript and be accountable for the manuscript’s contents. NP substantially contributed to the conception and design of the work, revise the manuscript, approved the final version of the manuscript and be accountable for the manuscript’s contents. GM substantially contributed to the conception of the work, revise the manuscript, approved the final version of the manuscript and be accountable for the manuscript’s contents. AS substantially contributed to the conception of the work, revise the manuscript, approved the final version of the manuscript and be accountable for the manuscript’s contents. BB substantially contributed to the conception of the work, revise the manuscript, approved the final version of the manuscript and be accountable for the manuscript’s contents. JL substantially contributed to the conception of the work, revise the manuscript, approved the final version of the manuscript and be accountable for the manuscript’s contents. LF substantially contributed to the conception of the work, revise the manuscript, approved the final version of the manuscript and be accountable for the manuscript’s contents. AGD substantially contributed to the conception of the work, revise the manuscript, approved the final version of the manuscript and be accountable for the manuscript’s contents. PL substantially contributed to the conception of the work, revise the manuscript, approved the final version of the manuscript and be accountable for the manuscript’s contents. JA substantially contributed to the conception of the work, revise the manuscript, approved the final version of the manuscript and be accountable for the manuscript’s contents. LB substantially contributed to the conception and design of the work, revise the manuscript, approved the final version of the manuscript and be accountable for the manuscript’s contents. MM substantially contributed to the conception and design of the work, revise the manuscript, approved the final version of the manuscript and be accountable for the manuscript’s contents.

Corresponding author

Correspondence to Pierre-Benoît Bonnefoy.

Ethics declarations

Conflict of interest

Dr. Bikdeli reports that he is a consulting expert, on behalf of the plaintiff, for litigation related to two specific brand models of IVC filters. Dr. Bertoletti reports personal fees and other from Bayer, personal fees and other from BMS, personal fees and other from Pfizer, personal fees and other from Léo-Pharma, non-financial support from Sanofi, outside the submitted work. The others authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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Ethical approval (include appropriate approvals or waivers)

All patients provided informed consent according to the requirements of the ethics committees at participating hospitals.

Consent to participate (include appropriate statements)

Informed consent was obtained from all individual participants included in the study.

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Not applicable.

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Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

A full list of the RIETE investigators is given in the online appendix.

Supplementary Information

Below is the link to the electronic supplementary material.

11239_2021_2579_MOESM1_ESM.docx

Supplementary information 1: Characteristics of patients with symptomatic PE included in RIETE from 2007 to 2019 and variation according regional factors. *SEM standard error of the mean, IQR interquartile range, sPESI simplified pulmonary embolism severity index (DOCX 17 KB)

11239_2021_2579_MOESM2_ESM.docx

Supplementary information 2: Variation in characteristics of patients with symptomatic PE included in RIETE from 2007 to 2019 based on hospital size and techniques availability. *SEM standard error of the mean, IQR interquartile range, sPESI simplified pulmonary embolism severity index (DOCX 17 KB)

11239_2021_2579_MOESM3_ESM.docx

Supplementary information 3: Characteristics of patient diagnosed with >1 thoracic imaging modality (2007-2019 period).SD standard deviation, IQR interquartile range, sPESI simplified pulmonary embolism severity index, DVT deep vein thrombosis (DOCX 18 KB)

11239_2021_2579_MOESM4_ESM.docx

Supplementary information 4: Characteristics of patient included in multivariable analysis. V/Q scan ventilation/perfusion lung scan, CTPA computed tomography pulmonary angiography, CrCl creatinin clearance, Sat O2 oxygen saturation, SBP systolic blood pressure, pDVT proximal deep venous thrombosis, SD standar deviation, IQR interquartile range, sPESI simplified pulmonary embolism severity index, DVT deep vein thrombosis (DOCX 20 KB)

Supplementary information 5: Members of the RIETE group (DOCX 15 KB)

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Bonnefoy, PB., Prevot, N., Mehdipoor, G. et al. Ventilation/perfusion (V/Q) scanning in contemporary patients with pulmonary embolism: utilization rates and predictors of use in a multinational study. J Thromb Thrombolysis 53, 829–840 (2022). https://doi.org/10.1007/s11239-021-02579-0

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