Echocardiographic parameters analysis in acute pulmonary embolism: what is the prognostic value in the real-world setting?

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Transthoracic echocardiogram performed after the diagnosis of acute pulmonary embolism is used for risk stratification. The individual prognostic value of the echocardiographic parameters and its association with the clinical data is still being studied. Objective To determine the impact of echocardiographic parameters (TAPSE, PSAP e TAPSE/PSAP), as well as its association with the clinical evaluation in the patient’s prognosis. Methods Single centre retrospective study, evaluating 131 patients admitted by acute pulmonary embolism between January 2017 and December 2020. Mean age was 67.6 ± 15.3 years, 38 patients were male (29.0%). The patients were stratified according to the European Cardiology Association (ESC) early mortality risk classification in high or intermediate-high risk (group A) and low or intermediate low risk (group B). The correlation with echocardiographic parameters was evaluated. In-hospital mortality at 30 days and 1 year was determined. Results Group A included 27 patients (20.6%) and group B 104 patients (79.4%), with no difference regarding demographic and clinic characteristics between both groups. In group A the mean PSAP was 49.4 ± 22.8 mmHg, TAPSE 14.7 ± 5.2 mm and TAPSE/PSAP 0.3. In group B the mean PSAP was 34.6 ± 16.8 mmHg, TAPSE 20.9 ± 4.5 mm and TAPSE/PSAP 0.7. The ROC analysis shows PSAP has good discriminative power for risk stratification (AUC 0.716; p = 0.017 95% CI 0.56 – 0.87), with a cut-off point at 35 mmHg. The TAPSE/PSAP ratio has an excellent discriminative power (AUC 0.873, p value 0.001, CI 95% 0.767 – 0.978), with a cut-off point of 0.3. In-hospital mortality was 8.4% (11 patients), 30-day mortality was 12.2% (16 patients) and 1-year mortality was 19.8% (26 patients). There was no difference regarding mortality between groups A and B. Comparing PSAP and TAPSE/PSAP ≤ 0.3, only the latter was correlated with mortality at 1 year (p = 0.021). The addition of TAPSE/PSAP ≤ 0.3 to ESC classification for each group had a significant impact on mortality at 1 year (p = 0.004). Conclusion The addition of TAPSE/PSAP ≤ 0.3 to risk scores in groups A and B confers relevant prognostic information on long-term mortality. When available, the addition of echocardiographic parameters to the clinical data could add relevant prognostic value.