Prognostic value of echocardiographic parameters in patients with pulmonary embolism

Netylko J.E.: Lomonosov Moscow State University, Moscow, Russia

Teterina M.A.: Peoples Friendship University of Russia (PFUR), Vinogradov City Clinical Hospital, Moscow, Russia

Pisaryuk A.S.: Peoples Friendship University of Russia (PFUR), Vinogradov City Clinical Hospital, Moscow, Russia

Goreva L.A.: Peoples Friendship University of Russia (PFUR), Vinogradov City Clinical Hospital, Moscow, Russia

Lukina O.I.: Peoples Friendship University of Russia (PFUR), Vinogradov City Clinical Hospital, Moscow, Russia

Safarova A.F.: Peoples' Friendship University of Russia (RUDN), Vinogradov City Clinical Hospital, Moscow, Russia

Merai I.: Peoples Friendship University of Russia (PFUR), Vinogradov City Clinical Hospital, Moscow, Russia

Kobalava Zh.D.: Peoples Friendship University of Russia (PFUR), Vinogradov City Clinical Hospital, Moscow, Russia

Download in PDF

Summary

Aim

To assess the value of echocardiographic parameters in predicting hospital death in patients with pulmonary embolism (PE).

Material and methods

Ninenty one patients with PE were enrolled in a retrospective study. At admission to the hospital, we performed transthoracic echocardiography to measure pulmonary artery systolic pressure (PASP), tricuspid annular plane systolic excursion (TAPSE) and TAPSE/PASP ratio, and to evaluate the presence of hypokinesis of the right ventricular (RV) wall and thrombosis in the right heart cavities.

Results

Eleven (12.1%) patients died during hospital stay. Deceased patients more often than survivors presented with D-like left ventricle (72.7% vs. 50.0%, p = 0.03), thrombus in the right heart cavities (18.2% vs. 2,5%, p = 0.02), and TAPSE<16 mm (90.9% vs. 33.8%, p <0.01). PASP was significantly increased in both groups and did not differ significantly between deceased and surviving patients (62.3 and 62.0 mm Hg respectively, p = 0.48), whereas TAPSE and TAPSE/PASP ratio were signficantly lower in deceased patients (14.2 vs. 18.6 mm, p = 0.002, and 0.23 vs. 0.33, p = 0.02, respectively). TAPSE<16 mm was associated with an increased risk of hospital death (odds ratio 14.8, 95% CI 1.8-120.7; p < 0.001). TAPSE/PASP ratio of less than 0.4 did not predict hospital death (odds ratio 4.5, 95% CI 0.55-36.5, p = 0.09). In the ROC analysis, the area under the curve was maximum for TAPSE<16 mm (AUC = 0.77).

Conclusion

In patients with PE, TAPSE less than 16 mm was an independent predictor of hospital mortality.

Key words

Pulmonary embolism, echocardiography, prognosis, dysfunction of the right ventricle, TAPSE, PASP