64 - Validating Artificial Intelligence-Guided RV/LV Analysis in Detecting and Predicting the Outcome of Pulmonary Embolisms
A. R. Hu, S. Gutti, D. Iyer, D. Scher, S. Sarin
Purpose: Pulmonary embolisms (PE) are potentially life-threatening manifestations of venous thromboembolic events (VTE). In cases of suspected PE, it is essential to rapidly triage patients and determine the severity of VTE and what resources may be required to optimize outcomes. This retrospective study was conducted using Imbio’s FDA-cleared automated right ventricle/left ventricle (RV/LV) analysis software to assess its predictive ability and to evaluate success Endovascular Thrombectomy (ET) using pre- and post-procedural chest CT pulmonary angiograms (CTPA), respectively.
Material and Methods: We reviewed 3 years of EMR data to identify ET cases performed at our institution. Inclusion criteria were cases that utilized Inari FlowTriever for ET and presence of pre- and post-procedural CTPA. Imbio’s RV/LV software was then utilized to measure ventricular dilation. RV/LV ratios greater than 0.9 according to pre-procedural CPTA were defined as abnormal by the software. Clinical success was defined as improvement of RV/LV ratio and no VTE or ET related complications.
Results: Out of 73 ET cases performed between December 2018 and December 2021, 10 were randomly chosen (5 patients who were placed on ECMO and 5 who were not). Average change in pre- vs post-procedural RV/LV ratios was higher in patients who were placed on ECMO (0.847±0.378 (ECMO) vs 0.292±0.180 (non-ECMO), P< 0.05). While average post-procedural RV/LV ratios were not significantly different (1.101±0.289 (ECMO) vs. 1.066±0.089 (non-ECMO)), average pre-procedural RV/LV ratios were significantly higher in patients who were placed on ECMO (1.948±0.275 (ECMO) vs. 1.359±0.127 (non-ECMO), P< 0.005). Of note, this difference was not found to be correlated with the number of days elapsed before the post-procedural CPTA was taken (5.2±2.6 (ECMO) vs 3.8±1.3 (non-ECMO)).
Conclusions: ET using Inari FlowTriever offers effective therapy for patients with moderate to severe PE. Results from this validation further suggest that even patients with low to intermediate RV strain may benefit from ECMO support during ET. Moreover, our study demonstrates the benefits to using artificial intelligence RV/LV analyses to assist in triaging VTE and deciding which resources to utilize. Such technologies should likely become a routine part of PE Response Teams (PERT) to assist in triage and optimize outcomes in intermediate to high-risk VTE patients.