Low left ventricular outflow tract velocity time integral is associated with poor outcomes in acute pulmonary embolism

Abstract

The left ventricular outflow tract (LVOT) velocity time integral (VTI) is an easily measured echocardiographic stroke volume index analog. Low values predict adverse outcomes in left ventricular failure. We postulate the left ventricular VTI may be a signal of right ventricular dysfunction in acute pulmonary embolism, and therefore a predictor of poor outcomes. We retrospectively reviewed echocardiograms on all Pulmonary Embolism Response Team activations at our institution at the time of pulmonary embolism diagnosis. Low LVOT VTI was defined as ⩽ 15 cm. We examined two composite outcomes: (1) in-hospital death or cardiac arrest; and (2) shock or need for primary reperfusion therapies. Sixty-one of 188 patients (32%) had a LVOT VTI of ⩽ 15 cm. Low VTI was associated with in-hospital death or cardiac arrest (odds ratio (OR) 6, 95% CI 2, 17.9; p = 0.0014) and shock or need for reperfusion (OR 23.3, 95% CI 6.6, 82.1; p < 0.0001). In a multivariable model, LVOT VTI ⩽ 15 remained significant for death or cardiac arrest (OR 3.48, 95% CI 1.02, 11.9; p = 0.047) and for shock or need for reperfusion (OR 8.12, 95% CI 1.62, 40.66; p = 0.011). Among intermediate–high-risk patients, low VTI was the only variable associated with the composite outcome of death, cardiac arrest, shock, or need for reperfusion (OR 14, 95% CI 1.7, 118.4; p = 0.015). LVOT VTI is associated with adverse short-term outcomes in acute pulmonary embolism. The VTI may help risk stratify patients with intermediate–high-risk pulmonary embolism.

Rationale for using the velocity–time integral and the minute distance for assessing the stroke volume and cardiac output in point-of-care settings

“…With the PLR test, a > 12% increase in the VTI after a PLR has demonstrated a good accuracy for differentiating fluid responders from non-responders [27,28]. Besides its value in hemodynamic monitoring, there is also a role of the LVOT VTI for predicting outcomes in selected populations, as seen in patients with acute decompensated heart failure [31] and in patients with acute pulmonary embolism [32], where a very low LVOT VTI (< 10 cm) and a low LVOT VTI (< 15 cm) is associated with worse prognosis, respectively. In other study, a low LVOT VTI (< 15 cm) correlates with a low CO syndrome in patients with acute decompensated heart failure and predicts the use of inotropes [33].…”

Pulmonary embolism in the presence of chronic heart failure syndrome: A structural-functional state of the cardiovascular system

“…В отношении ТЭЛА преимущество данной концепции связано с чрезвычайной гетерогенностью клинических проявлений: от бессимптомного течения до остановки сердца, разноплановостью характера предрасполагающих факторов, различными терапевтическими стратегиями для пациентов, относящихся к определенным группам риска, а также с высоким уровнем коморбидности. Командная работа с привлечением нескольких экспертов для выработки оптимального, скоординированного и всестороннего плана ведения для каждого пациента с ТЭЛА требует учета сопутствующей патологии, которая может влиять на процессы диагностики и лечения [3][4][5][6].…”

Relationship of left ventricular outflow tract velocity time integral to treatment strategy in submassive and massive pulmonary embolism

“…Left ventricular outflow tract velocity time integral (LVOT VTI), an echocardiographic measurement of stroke volume (SV), a component of cardiac output, has been demonstrated to be a predictor of outcomes in acute PE, including death, cardiac arrest, shock or need for reperfusion. 13 The objective of this study was to compare the effects of systemic thrombolytics versus catheter-directed thrombolytics versus anticoagulation alone on LVOT VTI as well as weighing composite bleeding outcomes in patients with submassive and massive PE.…”