1. Echocardiographic predictors of mortality in intermediate-risk pulmonary embolism
- Author
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Lorenzo Falsetti, Alberto Maria Marra, Vincenzo Zaccone, Mattia Sampaolesi, Francesca Riccomi, Laura Giovenali, Emanuele Guerrieri, Giovanna Viticchi, Anna D’Agostino, Tamira Gentili, Cinzia Nitti, Gianluca Moroncini, Antonio. Cittadini, Aldo Salvi, Falsetti, L., Marra, A. M., Zaccone, V., Sampaolesi, M., Riccomi, F., Giovenali, L., Guerrieri, E., Viticchi, G., D'Agostino, A., Gentili, T., Nitti, C., Moroncini, G., Cittadini, A., and Salvi, A.
- Subjects
Aged, 80 and over ,Male ,Systole ,Transthoracic echocardiography ,Ventricular Dysfunction, Right ,Troponin I ,Pulmonary embolism ,Middle Aged ,Prognosis ,Critical care ,Echocardiography ,Emergency Medicine ,Internal Medicine ,Humans ,Female ,Aged ,Risk assessment - Abstract
Data regarding further risk stratification of intermediate-risk pulmonary embolism (IR-PE) are scanty. Whether transthoracic echocardiography may be helpful in further risk assessment of death in such population has still to be proven. Two-hundred fifty-four consecutive patients (51.6% females, age 63.7 ± 17.3 years) with IR-PE admitted to a tertiary regional referral center were enrolled. Patients underwent a complete transthoracic echocardiography within 36 h from hospital admission, on top of clinical assessment, physical examination, computer tomography pulmonary angiography (CTPA), and serum measurement of Troponin I (TnI) levels. The occurrence of 90 day mortality was chosen as primary outcome measure. When compared to survivors, non-surviving IR-PE patients had smaller left-ventricular end-diastolic volumes (39.8 ± 20.9 vs 49.4 ± 19.9 ml/m2, p = 0.006) with reduced stroke volume index (SVi) (24.7 ± 10.9 vs 30.9 ± 12.6 ml/m2, p: 0.004) and time–velocity integral at left-ventricular outflow tract (VTILVOT) (0.17 ± 0.03 vs 0.20 ± 0.04 m, p = 0.0001), whereas no differences were recorded regarding right heart parameters. Cox regression analysis revealed that right atrial enlargement (RAE) (HR 3.432, 5–95% CI 1.193–9.876, p: 0.022), the ratio between tricuspid annulus plane excursion and pulmonary arterial systolic pressure (TAPSE/PASp) (HR 4.833, 5–95% 1.230–18.986, p = 0.024), as well as SVi (HR 11.199, 5–95% CI 2.697–48.096, p = 0.001) and VTILVOT (HR 4.212, 5–95% CI 1.384–12.820, p = 0.011) were powerful independent predictors of mortality. Neither CTPA RV/LV nor TnI resulted associated with impaired survival. In intermediate-risk pulmonary embolism, RAE, TAPSE/PASp ratio, SVi, and VTILVOT predict independently prognosis to a greater extent than CTPA and TnI.
- Published
- 2022