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