Clinical and echocardiographic predictors of mortality in acute pulmonary embolism.

Dahhan, Talal

Siddiqui, Irfan

Tapson, Victor F

Velazquez, Eric J

Sun, Stephanie

Davenport, Clemontina A

Samad, Zainab

Rajagopal, Sudarshan

England

2017-07-07T14:01:07Z

2017-07-07T14:01:07Z

2016-10-28

PURPOSE: The aim of this study was to evaluate the utility of adding quantitative assessments of cardiac function from echocardiography to clinical factors in predicting the outcome of patients with acute pulmonary embolism (PE). METHODS: Patients with a diagnosis of acute PE, based on a positive ventilation perfusion scan or computed tomography (CT) chest angiogram, were identified using the Duke University Hospital Database. Of these, 69 had echocardiograms within 24-48 h of the diagnosis that were suitable for offline analysis. Clinical features that were analyzed included age, gender, body mass index, vital signs and comorbidities. Echocardiographic parameters that were analyzed included left ventricular (LV) ejection fraction (EF), regional, free wall and global RV speckle-tracking strain, RV fraction area change (RVFAC), Tricuspid Annular Plane Systolic Excursion (TAPSE), pulmonary artery acceleration time (PAAT) and RV myocardial performance (Tei) index. Univariable and multivariable regression statistical analysis models were used. RESULTS: Out of 69 patients with acute PE, the median age was 55 and 48 % were female. The median body mass index (BMI) was 27 kg/m(2). Twenty-nine percent of the cohort had a history of cancer, with a significant increase in cancer prevalence in non-survivors (57 % vs 29 %, p = 0.02). Clinical parameters including heart rate, respiratory rate, troponin T level, active malignancy, hypertension and COPD were higher among non-survivors when compared to survivors (p ≤ 0.05). Using univariable analysis, NYHA class III symptoms, hypoxemia on presentation, tachycardia, tachypnea, elevation in Troponin T, absence of hypertension, active malignancy and chronic obstructive pulmonary disease (COPD) were increased in non-survivors compared to survivors (p ≤ 0.05). In multivariable models, RV Tei Index, global and free (lateral) wall RVLS were found to be negatively associated with survival probability after adjusting for age, gender and systolic blood pressure (p ≤ 0.05). CONCLUSION: The addition of echocardiographic assessment of RV function to clinical parameters improved the prediction of outcomes for patients with acute PE. Larger studies are needed to validate these findings.

https://www.ncbi.nlm.nih.gov/pubmed/27793158

10.1186/s12947-016-0087-y

1476-7120

https://hdl.handle.net/10161/15031

eng

Springer Science and Business Media LLC

Cardiovasc Ultrasound

10.1186/s12947-016-0087-y

Echocardiography

Pulmonary embolism

Right ventricular function

Speckle-tracking echocardiography

Acute Disease

Adult

Aged

Echocardiography, Doppler

Female

Follow-Up Studies

Heart Ventricles

Humans

Male

Middle Aged

Pulmonary Embolism

Retrospective Studies

Survival Rate

United States

Ventricular Dysfunction, Right

Clinical and echocardiographic predictors of mortality in acute pulmonary embolism.

Journal article

Velazquez, Eric J|0000-0003-2245-7477

Rajagopal, Sudarshan|0000-0002-3443-5040

https://www.ncbi.nlm.nih.gov/pubmed/27793158

44

1

Basic Science Departments

Biochemistry

Clinical Science Departments

Duke

Duke Clinical Research Institute

Institutes and Centers

Medicine

Medicine, Cardiology

Medicine, Pulmonary, Allergy, and Critical Care Medicine

School of Medicine

Published online

14