Right Atrial Size and 30-Day Mortality in Normotensive Patients with Pulmonary Embolism

Background: The role of right atrial (RA) dilatation for predicting mortality in normotensive patients with pulmonary embolism (PE) has not been thoroughly studied. Methods: We used the RIETE Registry data to evaluate the prognostic value of RA dilatation (visual estimate) on transthoracic echocardiography (ETT) in patients with acute PE presenting with systolic blood pressure levels ≥90 mm Hg. Results: As of April 2013, 7,677 normotensive patients with acute PE underwent ETT within the first 48 hours. Of these, 2,268 (29.5%) had RA dilatation. At 30 days, 212 patients (2.76%) died, of whom 59 (0.77%) died of confirmed PE. Patients with RA dilatation had a 6-fold higher rate of fatal PE (1.85% vs. 0.31%; odds ratio [OR]: 5.98; 95% CI: 3.44-10.8) and a 2-fold higher all-cause mortality (4.32% vs. 2.11%; OR: 2.10; 95% CI: 1.59-2.76) compared with those without RA dilatation. On multivariable analysis, RA dilatation independently predicted fatal PE (relative risk [RR]: 3.71; 95% CI: 1.68-8.17), while right ventricle hypokinesis did not (RR: 1.36; 95% CI: 0.66-2.80). Conclusions: Among normotensive patients with acute PE, RA dilatation on ETT independently predicted fatal PE at 30 days.