Right Ventricular Echocardiographic Parameters Are Associated with Mortality after Acute Pulmonary Embolism

Khemasuwan, Danai; Yingchoncharoen, Teerapat; Tunsupon, Pichapong; Kusunose, Kenya; Moghekar, Ajit; Klein, Allan L.; Tonelli, Adriano R.

doi:10.1016/j.echo.2014.11.012

Cited by 73 publications

(51 citation statements)

References 45 publications

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“…In addition, they revealed the relationship between RV dysfunction and short-and long-term mortality. [21][22][23][24][25][26][27][28] These findings are associated with our results.…”

Section: Discussionsupporting

confidence: 93%

Assessment of right ventricular function and relation to mortality after acute pulmonary embolism: A speckle tracking echocardiography‐based study

et al. 2019

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Purpose Right ventricular (RV) dysfunction is a common condition that is related to increased adverse outcomes in patients with acute pulmonary embolism (APE). Our aim was to assess timing and magnitude of regional RV function using speckle tracking echocardiography (STE) and to evaluate their relationship to long‐term mortality in patients after APE. Methods In total, 147 patients were enrolled at the onset of an APE episode and followed for 12 ± 1.1 months. For all patients, the clinical, laboratory, and echocardiography examinations were performed at the diagnosis of APE and at the end of the 1‐year follow‐up. Results Of the 147 patients, 44 (29.9%) died during the 1‐year follow‐up after APE. The patients who died had lower RV free wall peak longitudinal systolic strains (PLSS) and left ventricular (LV) PLSS and higher RV peak systolic strain dispersion (PSSD) index which means the electromechanical dispersion when compared with the survivors. The difference in time to PLSS between the RV free wall and LV lateral wall (RVF–LVL) which means the electromechanical delay was longer in patients who died than in those who survived during follow‐up, and this difference was an independent predictor of mortality at 1 year of follow‐up after APE, with 86.4% sensitivity and 81.7% specificity. At the end of 1‐year follow‐up, the RV free wall PLSS and the LV global PLSS increased, whereas the RV PSSD index and the difference in time to PLSS between the RVF and LVL decreased. Conclusions Acute pulmonary embolism was associated with RV dysfunction and RV electromechanical delay and dispersion. These parameters improved at the end of 1‐year follow‐up. The electromechanical delay index might be a useful predictor of mortality in patients after APE.

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“…In addition, they revealed the relationship between RV dysfunction and short-and long-term mortality. [21][22][23][24][25][26][27][28] These findings are associated with our results.…”

Section: Discussionsupporting

confidence: 93%

Assessment of right ventricular function and relation to mortality after acute pulmonary embolism: A speckle tracking echocardiography‐based study

et al. 2019

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“…The negative effect of invasive mechanical ventilation was reported in some other studies as well [14–16] Soh et al also reported that intubation was more frequent in the nonsurvivors in their study [14]. Khemasuwan et al reported that the need for mechanical ventilation was associated with both ICU (OR, 12.0; 95% CI, 4.6–32.3) and hospital (OR, 11.9; 95% CI, 5.3–27.0) mortality [15, 16]. Positive pressure ventilation can have devastating effects on a patient with circulatory collapse from PE.…”

Section: Discussionmentioning

confidence: 66%

Mortality Related Risk Factors in High-Risk Pulmonary Embolism in the ICU

Ergan

Ergün

Çalışkan

et al. 2016

Canadian Respiratory Journal

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Introduction. We sought to identify possible risk factors associated with mortality in patients with high-risk pulmonary embolism (PE) after intensive care unit (ICU) admission. Patients and Methods. PE patients, diagnosed with computer tomography pulmonary angiography, were included from two ICUs and were categorized into groups: group 1 high-risk patients and group 2 intermediate/low-risk patients. Results. Fifty-six patients were included. Of them, 41 (73.2%) were group 1 and 15 (26.7%) were group 2. When compared to group 2, need for vasopressor therapy (0 vs 68.3%; p < 0.001) and need for invasive mechanical ventilation (6.7 vs 36.6%; p = 0.043) were more frequent in group 1. The treatment of choice for group 1 was thrombolytic therapy in 29 (70.7%) and anticoagulation in 12 (29.3%) patients. ICU mortality for group 1 was 31.7% (n = 13). In multivariate logistic regression analysis, APACHE II score >18 (OR 42.47 95% CI 1.50–1201.1), invasive mechanical ventilation (OR 30.10 95% CI 1.96–463.31), and thrombolytic therapy (OR 0.03 95% CI 0.01–0.98) were found as independent predictors of mortality. Conclusion. In high-risk PE, admission APACHE II score and need for invasive mechanical ventilation may predict death in ICU. Thrombolytic therapy seems to be beneficial in these patients.

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“…While subjective RV dysfunction has been associated with worse outcomes in PE [31], a number of studies suggest that quantifiers of RV function may better identify high-risk patients, although most of these studies did not test the utility of such parameters in combination with clinical characteristics [11, 13–21]. For example, RV dysfunction, as assessed by tricuspid annular plane systolic excursion (TAPSE) and RV myocardial performance (Tei) index, has been characterized in patients with PE [32, 33].…”

Section: Discussionmentioning

confidence: 99%

“…For example, RV dysfunction, as assessed by tricuspid annular plane systolic excursion (TAPSE) and RV myocardial performance (Tei) index, has been characterized in patients with PE [32, 33]. Another recent study identified the ratio of RV to LV end-diastolic diameter, RV systolic pressure, tricuspid annular plane systolic excursion, and inferior vena cava collapsibility to be independently associated with mortality in patients presenting with acute PE [11]. Abnormal RV global and free wall speckle-tracking strains have been associated with adverse events in patients with PE [27].…”

Section: Discussionmentioning

confidence: 99%

Clinical and echocardiographic predictors of mortality in acute pulmonary embolism

Dahhan

Siddiqui

Tapson

et al. 2016

Cardiovasc Ultrasound

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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.

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Right Ventricular Echocardiographic Parameters Are Associated with Mortality after Acute Pulmonary Embolism

Cited by 73 publications

References 45 publications

Assessment of right ventricular function and relation to mortality after acute pulmonary embolism: A speckle tracking echocardiography‐based study

Assessment of right ventricular function and relation to mortality after acute pulmonary embolism: A speckle tracking echocardiography‐based study

Mortality Related Risk Factors in High-Risk Pulmonary Embolism in the ICU

Clinical and echocardiographic predictors of mortality in acute pulmonary embolism

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