Clinical InvestigationRight Ventricular Overload and RV FunctionRight Ventricular Echocardiographic Parameters Are Associated with Mortality after Acute Pulmonary Embolism
Section snippets
Subjects and Study Protocol
This was a single-center, retrospective cohort study that was approved by the Cleveland Clinic Institutional Review Board. We identified patients with acute PE admitted to Cleveland Clinic between February 2009 and January 2013 using the International Classification of Diseases, Ninth Revision, codes for PE and pulmonary infarction (415.1 and V12.51). For this analysis, we identified 235 patients who (1) had confirmed diagnoses of PE by computed tomographic angiography of the chest and/or a
Overall Patient Characteristics
We included a total of 211 patients in the final analysis. Patients had a mean age of 61 ± 15 years, and 107 (51%) were women. The majority were Caucasian (77%) or African American (22%). Three-quarters of the patients (n = 160 [76%]) were initially admitted to the ICU. Risk factors for the development of PE are shown in Table 1. Interestingly, 32 patients (15%) had at least two risk factors for PE. Among patients with histories of malignancy (n = 70), 34 were receiving chemotherapy at the
Discussion
In this single-center cohort of patients with acute PE admitted to a medical ICU, we examined whether certain echocardiographic parameters of interest relate to clinical outcomes. LV EDD, LVEF, estimated RVSP, and IVC collapsibility were associated with ICU mortality. Meanwhile, RV/LV EDD ratio, LV EDD, estimated RVSP, maximum TR jet velocity, leftward shifting of the IVS, and IVC collapsibility were associated with hospital mortality. An increase in the RV/LV EDD ratio or decreases in LV EDD,
Conclusions
Our study demonstrates that simple echocardiographic parameters are associated with ICU, hospital, and long-term mortality in patients presenting with acute PE. RV strain analysis by speckle-tracking imaging was not correlated with hospital or long-term mortality.
Acknowledgments
The authors thank Dr. Jorge Guzman for contributing the data on APACHE IV scores of ICU patients.
References (45)
- et al.
Multidetector CT scan for acute pulmonary embolism: embolic burden and clinical outcome
Chest
(2012) - et al.
Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography
J Am Soc Echocardiogr
(2010) - et al.
Independent and incremental role of quantitative right ventricular evaluation for the prediction of right ventricular failure after left ventricular assist device implantation
J Am Coll Cardiol
(2012) - et al.
Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology
J Am Soc Echocardiogr
(2005) - et al.
Mortality Probability Model III and Simplified Acute Physiology Score II: assessing their value in predicting length of stay and comparison to APACHE IV
Chest
(2009) - et al.
Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry
J Am Coll Cardiol
(1997) - et al.
Point-of-care focused cardiac ultrasound for prediction of pulmonary embolism adverse outcomes
J Emerg Med
(2013) - et al.
Prevalence and prognostic value of left ventricular diastolic dysfunction in idiopathic and heritable pulmonary arterial hypertension
Chest
(2012) - et al.
Quantitative two-dimensional echocardiography in massive pulmonary embolism: emphasis on ventricular interdependence and leftward septal displacement
J Am Coll Cardiol
(1987) - et al.
Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER)
Lancet
(1999)