Re-appraisal of echocardiographic assessment in patients with pulmonary embolism: Prospective blinded long-term follow-up

Hezzy Shmueli, Arie Steinvil, Galit Aviram, Moaad Sileman, Sharon Adam, Achiude Bendet, Simon Biner, Yacov Shacham, Jack Sherez, Ricki Megidish, Yifat Hasin, Ester Elazar, Sevan Letourneau-Shesaf, Gad Keren, Shlomo Berliner, Yan Topilsky

Research output: Contribution to journalReview articlepeer-review

Abstract

Background: Acute pulmonary embolism (PE) is considered to be one of the most common cardiovascular diseases with considerable mortality. Conflicting data imply possible role for echocardiography in assessing this disease. Objectives: To determine which of the echo parameters best predicts short-term and long-term mortality in patients with PE. Methods: We prospectively enrolled 235 patients who underwent computed tomography of pulmonary arteries (CTPA) and transthoracic Echocardiography (TTE) within less than 24 hours. TTE included a prospectively designed detailed evaluation of the right heart including right ventricular (RV) myocardial performance index (RIMP), RV end diastolic and end systolic area, RV fractional area change, acceleration time (AT) of pulmonary flow and visual estimation. Interpretation and performance of TTE were blinded to the CTPA results. Results: Although multiple TTE parameters were associated with PE, all had low discriminative capacity (AUC < 0.7]. Parameters associated with 30-day mortality in univariate analysis were acceleration time (AT) < 81 msec (P = 0.04), stroke volume < 44 cc (P = 0.005), and RIMP > 0.42 (P = 0.05). The only RV independent echo parameter associated with poor long-term prognosis (adjusted for significant clinical, and routine echo associates of mortality) was RIMP (hazard ratio 3.0, P = 0.04). The only independent RV echo parameters associated with mortality in PE patients were RIMP (P = 0.05) and AT (P = 0.05). The addition of RIMP to nested models eliminated the significance of all other parameters assessing RV function. Conclusions: Doppler-based parameters like pulmonary flow AT, RIMP, and stroke volume, have additive value on top of visual RV estimation to assess prognosis in patients with PE.

Original languageEnglish
Pages (from-to)688-695
Number of pages8
JournalIsrael Medical Association Journal
Volume22
Issue number11
StatePublished - Nov 2020
Externally publishedYes

Keywords

  • Computed tomography pulmonary arteries (CTPA)
  • Doppler
  • Echocardiography
  • Pulmonary embolism
  • Right ventricle

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