Abstract 14176: Pulmonary Effective Artery Elastance as a Novel Predictor of Adverse Events in Patients With Pulmonary Embolism

Abstract

Introduction: Risk stratification tools including the Pulmonary Embolism Severity Index (PESI) and BOVA rely on complicated calculations that give less attention to hemodynamic parameters predictive of cardiogenic shock in acute pulmonary embolism (PE). We explored the possibility that simultaneous measurement of right sided and left sided non-invasive hemodynamic parameters by echocardiography may predict adverse sequelae in the context of acute PE. Methods: We retrospectively reviewed all Pulmonary Embolism Response Team (PERT) activations between 2014 and 2020. The PESI and BOVA scores were calculated and their performance in predicting adverse events was compared to pulmonary artery elastance (PAE). PAE (mmHg/mL) was calculated by dividing the Pulmonary Artery Systolic pressure (PASP) by the LV Stroke (SV). Blood biomarkers (troponin T, NT-proBNP, and lactate) were recorded. The composite primary outcome was: 1) need for advanced intervention, 2) cardiac arrest, and 3) in-hospital mortality. Multivariate and univariate regression was used to analyze outcomes. Results: 215 of 343 patients met inclusion criteria. Baseline characteristics were similar in patients with PAE <1 and PAE ≥ 1. PAE ≥ 1 was common in intermediate-high risk PE (85.7% vs 63.1%, p <0.001), with greater [NT-proBNP, pg/mL] (3599 vs 1427.5, p=0.001) and [lactate, mM] (2.9 vs 1.8. p=0.003). PAE ≥ 1 predicted the composite endpoint with odds ratio (OR) of 2.31 (95% CI 1.3-4.2, p=0.005), Comparatively BOVA had adjusted OR of 1.3 (95% CI, 1.1-1.6, p = 0.01) and PESI was not significant with OR of 1.4 (95% CI, 1 -2.1, p = 0.055) in predicting composite outcomes. Conclusion: In the context of acute high risk PE, PAE ≥ 1.0 is a novel and independent predictor of adverse cardiovascular events and mortality that should be prospectively validated.