PURPOSE: To investigate if Right Ventricle Dysfunction (RVD) is associated with worse clinical outcome and increased length of stay in Pulmonary Embolism (PE) patients. Treatment of PE with RVD may impact survival using thrombolysis and different anticoagulant agents.
METHODS: Retrospective chart review of patients with confirmed PE and echocardiography done over two years period. Patients’ characteristics, echocardiographic findings of RV diameter and Right Ventricle/Left Ventricle diameter ratio, treatment modalities, length of stay and final outcome were recorded.
RESULTS: 83 charts with confirmed PE met the criteria for review. Mean age is 71.5 years with 2:1 female to male ratio. 45 patients with normal RV function (NRV) and 38 had evidence of RVD. Overall mortality rate was 9.6%. 15.7% of patients with PE and RVD died compared to 4.4% of those with PE and NRV (P<0.05). Average length of stay in PE with RVD and those with NRV was similar at 12.0 days. Among patients with PE and RVD, the mortality rate for those treated with low molecular weight heparin (LMWH) was 16.6% compared to 9% for those treated with unfractionated heparin (UH)(P=0.02). Mortality rate for PE with NRV treated with LMWH was 5.9% versus 0% for the ones treated with UH (P<0.05). Two patients recieved thrombolysis and both survived.
CONCLUSION: PE with RVD is associated with increase mortality compared to those with NRV but with similar length of stay. Treatment of PE using LMWH was associated with increased mortality especially among those with evidence of RVD compared to UH and thrombolysis.
CLINICAL IMPLICATIONS: Assessment of RV function in PE can help in risk stratification and prognosis. The use of LMWH in treatment of PE in particular with RVD should be thoroughly investigated further.
DISCLOSURE: Syed Ahmad, None.