Prognostic value of echocardiographic parameters for right ventricular function in patients with acute non-massive pulmonary embolism

Heart Vessels. 2019 Jul;34(7):1187-1195. doi: 10.1007/s00380-019-01340-1. Epub 2019 Jan 22.

Abstract

A prognostic value of right ventricular (RV) systolic function assessed by echocardiography in patients with acute non-massive pulmonary embolism (PE) remains controversial. The hypothesis was RV free wall strain measured using speckle-tracking echocardiography might be a powerful prognostic factor in those patients. We aimed to evaluate the prognostic value of echocardiographic measurements of RV systolic function for clinical outcomes and to assess the correlation between the echocardiographic RV function parameters in patients with acute non-massive PE. Between November 2013 and September 2016, 144 consecutive patients diagnosed as acute non-massive pulmonary embolism were prospectively enrolled and echocardiographic evaluations were performed within 1 week of diagnosis to measure various parameters of RV systolic function. The primary endpoint was in-hospital events, the composite of in-hospital PE-related death, need of additive treatments such as thrombolysis or pulmonary artery thromboembolectomy, and need of inotropics due to unstable vital sign. Among patients (mean age 60.3 ± 14.7 years, 50% female) with acute non-massive PE, the in-hospital event rate was 11.1% (16 of 144 patients). In multivariate logistic regression analysis, after adjustment of confounding factors such as age, gender, and diabetes mellitus, RV free wall strain [odd ratio (OR) 1.12, 95% confidence interval (CI) 1.04-1.21, p = 0.002] and RV global wall strain (OR 1.20, 95% CI 1.07-1.35, p = 0.002) were independent predictors for in-hospital events. The event rates were significantly different between groups classified based on RV free wall strain with cut-off value of - 15.85% (p < 0.001). RV strain assessed with speckle-tracking echocardiography is an independent prognostic marker for in-hospital events in patients with acute non-massive PE. Our results may help identify high-intermediate risk patients who need a closer monitoring.

Keywords: Echocardiography; Prognosis; Pulmonary embolism; Right ventricle dysfunction.

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Causality
  • Echocardiography*
  • Female
  • Hospital Mortality
  • Humans
  • Image Interpretation, Computer-Assisted / methods*
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Prospective Studies
  • Pulmonary Embolism / diagnostic imaging*
  • Pulmonary Embolism / mortality
  • Republic of Korea
  • Risk Assessment
  • Sensitivity and Specificity
  • Stroke Volume
  • Ventricular Dysfunction, Right / diagnostic imaging*
  • Ventricular Dysfunction, Right / mortality