PROGNOSTIC VALUE OF RIGHT VENTRICULAR DYSFUNCTION IN SUBMASSIVE PULMONARY EMBOLISM

Abstract

SESSION TITLE: Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Submassive pulmonary embolism (PE) conveys increased morbidity and mortality. Different clinical, laboratorial and imaging predictors for adverse outcomes have been assessed; however, the prognostic significance of the same remains unclear. We aimed to describe the prognostic value of right ventricular (RV) dysfunction for adverse outcomes in patients with submassive PE. METHODS: We retrospectively reviewed patients admitted with submassive PE at a tertiary urban medical center from 2010-2015. Submassive PE was defined by the presence of RV dysfunction by imaging, either with echocardiography or chest computed tomography (CT) scan or by the elevation of biomarkers including brain-natriuretic peptide above 600 pg/mL or troponin-T above 0.014 ug/L. The primary outcome was the presence of pulmonary hypertension evidenced at follow up by echocardiography or CT scan. Univariate analysis was conducted using Wilcoxon-Ranked Sum and Chi-squared test. Logistic regression was performed for multivariate analysis. RESULTS: A total of 96 patients were included in the study, with predominance of males (63%), and African Americans (70%). Mean of age (± SD) was 60±15 years. Presence of RV dysfunction was made by imaging tests alone in 62% of the cases and by biomarkers alone in 38%. The mean risk stratification class was IV, based on the Pulmonary Embolism Severity Index (PESI) score of 106 ±32. In the univariate analysis, RV dysfunction by imaging alone (p=0.004) and in combination with biomarkers (p=0.018) were associated with development of pulmonary hypertension, while the use of biomarkers alone was not. On multivariate analysis, RV dysfunction by imaging alone (Odds Ratio [OR]= 4.01, 95% Confidence Interval [CI] (1.43-11.21), p=0.011) and in combination with biomarkers (OR= 3.03, 95% CI (1.20-7.67), p=0.029) remained significantly associated with pulmonary hypertension after adjusting for history of respiratory disease and heart failure. CONCLUSIONS: Presence of RV dysfunction by imaging alone or in combination with biomarkers in patients with submassive PE independently predicted development of pulmonary hypertension after adjusting by important comorbidities including pulmonary diseases and heart failure. Use of biomarkers alone did not to have significant prognostic value. CLINICAL IMPLICATIONS: RV dysfunction by imaging may play an important role identifying patients at risk for development of pulmonary hypertension. DISCLOSURES: No relevant relationships by Naveen Prasath Baskaran, source=Web Response No relevant relationships by Sherene Fakhran, source=Admin input No relevant relationships by Rabab Nasim, source=Web Response No relevant relationships by Avantika Nathani, source=Web Response No relevant relationships by VICTOR PRADO, source=Web Response No relevant relationships by Sairam Raghavan, source=Web Response No relevant relationships by Connor Wakefield, source=Web Response