How to predict prognosis in patients with acute pulmonary embolism? Recent advances

Abstract

Pulmonary embolism (PE) is the third most frequent cardiovascular disease, characterized by a wide range of presentations and clinical courses. Prognostic assessment is a cornerstone of PE management as it determines the choice of both diagnostic and therapeutic strategies. During the previous decades significant efforts have been made to safely select patients for early discharge or home treatment, but appropriate risk stratification, particularly of intermediate-risk patients, remains challenging. In addition to the guideline-recommended clinical prediction rules, such as Pulmonary Embolism Severity Index (PESI), simplified PESI (sPESI), and/or Hestia criteria, a multimodality approach based also on biomarkers and cardiac imaging is crucial for risk-stratification and for selecting appropriate management of patients. In this review article, we discuss the current methods for predicting short and long-term prognosis in PE patients, focusing on the current guidelines, but also on the most recently proposed clinical prediction rules, biomarkers, and imaging parameters.

Echocardiographic parameters as adjuncts to the Pulmonary Embolism Severity Index in predicting 30-day mortality in acute pulmonary embolism patients

“…Predominantly, TTE parameters have been shown to be inferior to composed clinical scores [27]. Importantly, what we have demonstrated is that all these 4 quantitative parameters potentially measured in all patients i.e.…”

“…These values highly derive from study group populations characteristics and data collection manners. Analogically, the prediction value of TTE and its quality might vary among PE patients of different features and can be affected by the studies' design [27]. Noteworthy, TTE assessment should be based on simple reproducible ultrasound modalities as more advanced ones like speckle-tracking longitudinal strain measurement is highly operator and equipment dependent [16,34,35].…”

“…Moreover, as it exceeds the scope of this paper, we did not incorporate biochemical parameters in the analysis. Their inclusion and novel approach to prognosis in PE subjects with developing technologies and artificial intelligence are in the pipeline [27].…”