الفهرس 
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Abstract
This study was conducted as a prospective observational cross-sectional study in the Department of Chest Diseases and Tuberculosis at Assiut University Hospital.
The aim of this study was to evaluate the prognostic importance of computed tomography pulmonary artery obstruction index (CT-PAOI) and various laboratory tests in predicting right ventricular dysfunction (RVD) and 30- day mortality in patients with acute pulmonary embolism (APE).
Our study was approved by the Scientific Ethics Committee of the Faculty of Medicine, Assiut University. Eighty (80) patients were enrolled in this work during the period from January 2021 to November 2022. Informed consent to handle patient data for scientific purposes was obtained from the patient or accompanying person.
At the end of the study, we reported the following results:
1- The median pulmonary embolism severity index (PESI) was significantly higher in the RVD group compared to the no RVD group. Likewise, it was higher in non-survivors compared to survivors. PESI class III, IV and V were present in a statistically significant higher proportion in RVD and non-survivors. The PESI had high diagnostic accuracy in predicting RVD and mortality and had been found to be an independent predictor of mortality.
2- The median pulmonary artery obstruction index (PAOI), mean right ventricle/ left ventricle (RV/LV) ratio and mean main pulmonary artery (PA) diameter were significantly higher in RVD group compared to no RVD and also higher in non-survivors compared to survivors. RV/LV >1, Interventricular septal deviation and inferior vena cava (IVC) contrast reflux were found in a statistically significant higher percent in RVD compared to no RVD group and in non-survivors compared to survivors. Most CT parameters were able to predict RVD and mortality; these parameters included PAOI and PAOI% followed by RV/LV ratio then main PA diameter in order. Increased PAOI and main PA diameter were found to be independent predictors of mortality in patients with acute pulmonary embolism.
3- Regarding arterial blood gas (ABG) values, there was a statistically significant lower mean partial pressure of arterial oxygen (PaO2), lower mean saturation of peripheral capillary oxygen (Spo2) and higher alveolar-arterial oxygen (A-a O2) gradient in RVD compared to no RVD group and also in non-survivors compared to survivors.
4- We found a statistically significant higher median neutrophil-lymphocyte ratio (NLR), median platelet-lymphocyte ratio (PLR) and mean red cell distribution width (RDW) in RVD group compared to no RVD and no significant difference between both groups in median mean platelet volume (MPV). Also, there was a statistically significant higher median NLR, PLR in non survivors and no difference between non-survivors and survivors in median MPV and mean RDW.
5- There was statistically significant higher median C-reactive protein (CRP), D-dimer and troponin in RVD compared to no RVD. Likewise, these values were significantly higher in non-survivors compared to survivors.
6- The most blood markers capable of predicting RVD were A-a O2 gradient, serum troponin, CRP, D- dimer, NLR, RDW and PLR in order. Also, A-a O2 gradient was found to be an independent predictor of RVD.
7- ABG and serum markers able to predict mortality were D- dimer, A-a O2 gradient, serum troponin, NLR, CRP and PLR in order.