Pulmonary Vascular Disease |

Right Ventricular Echocardiographic Parameters Predict Mortality After Acute Pulmonary Embolism FREE TO VIEW

Danai Khemasuwan, MBA; Teerapat Yingchoncharoen; Pichapong Tunsupon; Kenya Kusunose; Allan Klein; Adriano Tonelli
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Cleveland Clinic, Cleveland, OH

Chest. 2014;146(4_MeetingAbstracts):818A. doi:10.1378/chest.1984291
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SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: There is limited information on the utility of these modern echocardiographic measurements in predicting mortality in acute pulmonary embolism (PE).

METHODS: We retrospectively identified 211 patients with acute PE admitted to the medical intensive care units (ICU). Conventional and modern echocardiographic variables were prospectively measured in this cohort. We focused on ICU, hospital and long-term mortality.

RESULTS: The mean ± SD age was 61±15 years. Median (IQR) APACHE IV and simplified Pulmonary Embolism Severity Index (PESI) were 60 (40-71) and 2 (1-2), respectively. Thirty eight (18%) patients died during the sentinel hospitalization (13% died in the ICU). A total of 61 (28.9%) patients died during a median (IQR) follow-up of 15 (5-26) months. The echocardiographic variables associated with long-term mortality were ratio of right to left ventricular end diastolic diameter (RV/LV EDD) (HR: 2.4 [1.2-4.8]), TAPSE (Tricuspid Annular Plane Systolic Excursion) (HR: 0.53[0.31-0.92]), and right ventricular-atrial gradient (HR: 1.02 [1.01-1.4]). ICU mortality was associated with RV/LVEDD (HR: 4.4 [1.3-15]), right ventricular systolic pressure (HR: 1.03 [1.01-1.05]), TAPSE (HR: 0.4 [0.18-0.9]), and Inferior Vena Cava (IVC) collapsibility < 50% (HR: 4.3 [1.7-11]). These variables remain significant predictors of mortality after adjusting them by, APACHE IV, PESI or the use of thrombolytics. Right ventricular strain parameters did not correlate with hospital or long-term mortality.

CONCLUSIONS: Four simple parameters that measure different aspects of the right ventricle (RV/LVEDD ratio, RVSP, TAPSE, and IVC collapsibility) were independent predictors of mortality in patients presenting with acute PE who were admitted to the ICU.

CLINICAL IMPLICATIONS: Simple echocardiographic parameters help clinicians to perform risk stratification in patients with submassive pulmonary embolism.

DISCLOSURE: The following authors have nothing to disclose: Danai Khemasuwan, Teerapat Yingchoncharoen, Pichapong Tunsupon, Kenya Kusunose, Allan Klein, Adriano Tonelli

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