Abstract 10864: Reduction in Right Ventricular Strain is Associated With Increased Mortality in Acute Pulmonary Embolism

Abstract

Introduction: Right ventricular (RV) systolic dysfunction has been identified as a prognostic marker for adverse clinical events in patients presenting with acute pulmonary embolism (PE). However, problems exist in identifying RV dysfunction using conventional echocardiography. Strain echocardiography is an evolving imaging modality which measures myocardial deformation and can be used as an objective index of RV systolic function. Hypothesis: We hypothesized that RV strain analysis is prognostic of mortality in patients with acute PE. Methods: Retrospective cohort study of 177 patients with acute PE between 2010 and 2017. Strain analysis was retroactively applied. All echocardiograms were completed within 48 hours of diagnosis. RV global longitudinal strain (RVGLS) was applied using TomTec®. The primary outcome was all-cause mortality at 30 days and in-hospital mortality. T-test statistical analysis was performed. Receiver operating characteristic (ROC) curves and Kaplan-Meier curves were used for evaluation. Results: Study quality was sufficient to perform RVGLS analysis in 157 patients (90.2%). Mortality at 30 days and in-hospital mortality occurred in 12.7% and 8.9% of patients respectively. Comparing 30-day mortality, there was a significant reduction in RVGLS compared to survivors (13.0% ± 3.0% vs 19.6% ± 3.5%, p < 0.001). In-hospital mortality as well showed a significant difference (13.1% ± 3.3% vs 19.3% ± 3.7%, p < 0.001). Using ROC curves, we chose a RVGLS value of 17.5% (sensitivity 90%, specificity 74%) to predict 30-day mortality. Patients with RVGLS worse than 17.5% had 18 times higher risk of 30-day mortality compared to patients with RVGLS better than 17.5% (HR 18.4, 95% CI= 4.2-79.7, p < 0.001. Figure). Conclusions: RV strain have significant prognostic value in patients with acute PE, and identifying those at higher risk of death. Assessment of RV strain has promise for clinical applications.