Abstract
PurposeThe aim of this study was to evaluate the utility of adding quantitative assessments of cardiac function from echocardiography to clinical factors in predicting the outcome of patients with acute pulmonary embolism (PE).MethodsPatients with a diagnosis of acute PE, based on a positive ventilation perfusion scan or computed tomography (CT) chest angiogram, were identified using the Duke University Hospital Database. Of these, 69 had echocardiograms within 24–48 h of the diagnosis that were suitable for offline analysis. Clinical features that were analyzed included age, gender, body mass index, vital signs and comorbidities. Echocardiographic parameters that were analyzed included left ventricular (LV) ejection fraction (EF), regional, free wall and global RV speckle-tracking strain, RV fraction area change (RVFAC), Tricuspid Annular Plane Systolic Excursion (TAPSE), pulmonary artery acceleration time (PAAT) and RV myocardial performance (Tei) index. Univariable and multivariable regression statistical analysis models were used.ResultsOut of 69 patients with acute PE, the median age was 55 and 48 % were female. The median body mass index (BMI) was 27 kg/m2. Twenty-nine percent of the cohort had a history of cancer, with a significant increase in cancer prevalence in non-survivors (57 % vs 29 %, p = 0.02). Clinical parameters including heart rate, respiratory rate, troponin T level, active malignancy, hypertension and COPD were higher among non-survivors when compared to survivors (p ≤ 0.05). Using univariable analysis, NYHA class III symptoms, hypoxemia on presentation, tachycardia, tachypnea, elevation in Troponin T, absence of hypertension, active malignancy and chronic obstructive pulmonary disease (COPD) were increased in non-survivors compared to survivors (p ≤ 0.05). In multivariable models, RV Tei Index, global and free (lateral) wall RVLS were found to be negatively associated with survival probability after adjusting for age, gender and systolic blood pressure (p ≤ 0.05).ConclusionThe addition of echocardiographic assessment of RV function to clinical parameters improved the prediction of outcomes for patients with acute PE. Larger studies are needed to validate these findings.
Highlights
Acute pulmonary Embolism (PE) is a major cause of morbidity and mortality in the United States and Europe, accounting for 100,000 and 300,000 deaths annually, respectively [1, 2]
Study population We retrospectively identified patients who had a diagnosis of acute PE between January 2010 and April 2014, confirmed by contrasted computed tomography (CT) scan of the chest and/or ventilation-perfusion (VQ) nuclear medicine imaging at Duke University Medical Center (Durham, NC, USA) using the Duke Enterprise Data Unified Content Explorer (DEDUCE) [24]
29 % (n = 20) of the cohort had a history of cancer, with a significantly higher prevalence in non-survivors compared to survivors (57 % vs. 29 %, p = 0.02)
Summary
Acute pulmonary Embolism (PE) is a major cause of morbidity and mortality in the United States and Europe, accounting for 100,000 and 300,000 deaths annually, respectively [1, 2]. The Pulmonary Embolism Severity Index (PESI) is an excellent clinical predictor of outcomes in patients with PE [6] It is based on 11 clinical criteria including age, sex, history of cancer and hemodynamic parameters. The simplified PESI (sPESI) was subsequently developed, with only six, rather than 11, clinical criteria In this index, only two risk categories were included, with low risk associated with 1.1 % mortality and high risk associated with an 8.9 % risk of death [7]. A number of studies [10,11,12,13,14,15,16,17,18,19,20,21] have tested the utility of novel echocardiographic or serum biomarkers for risk assessment in acute PE, but only a few studies have tested whether such parameters provide additional benefit to clinical predictors [22, 23].
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