Prognostic value of echocardiographic parameters in patients with pulmonary embolismDownload in PDF
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.
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).
In patients with PE, TAPSE less than 16 mm was an independent predictor of hospital mortality.
Pulmonary embolism, echocardiography, prognosis, dysfunction of the right ventricle, TAPSE, PASP