Simultaneous Pulmonary Artery Pressure and Left Ventricle Stroke Volume Assessment Predicts Adverse Events in Patients With Pulmonary Embolism

Kamran, Hayaan; Hariri, Essa; Iskandar, Jean‐Pierre; Sahai, Aditya; Haddadin, Ihab; Harb, Serge C.; Campbell, Joseph; Tefera, Leben; Delehanty, Joseph M.; Heresi, Gustavo A.; Bartholomew, John R.; Cameron, Scott J.

doi:10.1161/jaha.120.019849

Cited by 9 publications

(10 citation statements)

References 21 publications

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“…Continuous measures of RVD seem to provide a more clinically relevant spectrum of risk, although these should be considered hypothesis-generating given the relatively few studies and limited number of continuous markers of RVD. There are numerous other promising markers of RVD that leverage the pathophysiology of reduced cardiac output [18][19][20] and RV-pulmonary artery decoupling [21][22][23][24], which did not have enough studies with similar outcomes for analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Strategies to increase the positive predictive value of TTE-derived RVD are needed to identify patients at higher risk of PE-related events. It is possible that new RVD parameters such as VTI or RV-pulmonary artery decoupling [18][19][20][21][22][23][24] using higher thresholds to define RVD or continuous measures of RVD that provide a spectrum of risk in combination with multimodality approaches that incorporate imaging, biomarkers and clinical data may enhance PE risk stratification in the future [25,26].…”

Section: Discussionmentioning

confidence: 99%

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Prognostic value of echocardiography-derived right ventricular dysfunction in haemodynamically stable pulmonary embolism: a systematic review and meta-analysis

Prosperi-Porta

Ronksley²,

Kiamanesh³

et al. 2022

Eur Respir Rev

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BackgroundWe sought to determine the prognostic value of transthoracic echocardiography (TTE)-derived right ventricular dysfunction (RVD) in haemodynamically stable and intermediate-risk patients with acute pulmonary embolism (PE), evaluate continuous RVD parameters, and assess the literature quality.MethodsWe searched MEDLINE, Embase and the Cochrane Central Register of Controlled Trials for studies assessing TTE-derived RVD in haemodynamically stable PE that reported in-hospital adverse events within 30 days. We determined pooled odds ratios (ORs) using a random-effects model, created funnel plots, evaluated the Newcastle–Ottawa scale and performed Grading of Recommendations, Assessment, Development and Evaluation.ResultsBased on 55 studies (17 090 patients, 37.8% RVD), RVD was associated with combined adverse events (AEs) (OR 3.29, 95% confidence interval (CI) 2.59–4.18), mortality (OR 2.00, CI 1.66–2.40) and PE-related mortality (OR 4.01, CI 2.79–5.78). In intermediate-risk patients, RVD was associated with AEs (OR 1.99, CI 1.17–3.37) and PE-related mortality (OR 6.16, CI 1.33–28.40), but not mortality (OR 1.63, CI 0.76–3.48). Continuous RVD parameters provide a greater spectrum of risk compared to categorical RVD. We identified publication bias, poor methodological quality in 34/55 studies and overall low certainty of evidence.ConclusionsRVD is frequent in PE and associated with adverse outcomes. However, data quality and publication bias are limitations of existing evidence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prognostic value of echocardiography-derived right ventricular dysfunction in haemodynamically stable pulmonary embolism: a systematic review and meta-analysis

Prosperi-Porta

Ronksley²,

Kiamanesh³

et al. 2022

Eur Respir Rev

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“…who reported that only 270/326 (83%) patients had complete data [9,10]. Lastly, because performing a TTE was at the discretion of the attending physician, there have been some selection bias in this cohort (only 820/2067 patients had a TTE within 48 hours of diagnosis).…”

Section: Discussionmentioning

confidence: 95%

“…Current international guidelines on the diagnosis and management of PE recommend consideration of transthoracic echocardiography (TTE) for risk strati cation although there are no standardized echocardiographic measures to de ne the presence or absence of RVD [6]. The prognostic importance of TTE-derived RV-PA coupling indices such as tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) and stroke volume/PASP have been recently reported [7][8][9][10]. However, questions regarding the role of RV-PA coupling in PE still exist.…”

Section: Introductionmentioning

confidence: 99%

“…al. evaluated pulmonary artery systolic pressure (PASP) divided by left ventricular stroke volume and Lyhne et al and Falsetti et al evaluated TAPSE/PASP showing that these markers were associated with adverse outcomes in PE [8-10].Kamran et al concluded that PASP/left ventricular stroke volume was superior to the velocity time integral (VTI) although this was done comparing continuous odds ratios with different units[9]. However,Falsetti et al found no difference in the association with adverse outcomes between TAPSE/PASP and VTI when comparing categorical odds ratios.…”

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confidence: 99%

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Ventricular-arterial decoupling is associated with in-hospital adverse events in normotensive pulmonary embolism

Kiamanesh

Prosperi-Porta

Harper

et al. 2022

Int J Cardiovasc Imaging

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During acute pulmonary embolism (PE) a compensatory increase in right ventricular (RV) contractility is required to match increased afterload to maintain right ventricular-pulmonary arterial (RV-PA) coupling. The aim of this study was to assess the prognostic utility of RV-PA decoupling in acute PE. MethodsWe assessed the association between measures of transthoracic echocardiography (TTE)-derived RV-PA coupling including tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) and right ventricular fractional area change (FAC)/PASP as well as stroke volume index (SVI)/PASP (a measure of pulmonary artery capacitance) with adverse PE-related events (in-hospital PErelated mortality or cardiopulmonary decompensation) using logistic regression analysis. ResultsIn 820 normotensive patients TTE-derived markers of RV-PA coupling were associated with PE-related adverse events. For each 0.1mm/mmHg decrease in TAPSE/PASP the odds of an adverse event increased by 2.5-fold (adjusted OR (aOR) 2.49, 95% con dence interval (CI) 1.46-4.24, p = 0.001), for every 0.1%/mmHg decrease in FAC/PASP the odds of an adverse event increased by 1.4-fold (aOR 1.42, CI 1.09-1.86, p = 0.010), and for every 0.1mL/mmHg•m 2 decrease in SVI/PASP the odds of an event increased by 2.75-fold (aOR 2.78, CI 1.72-4.50, p < 0.001). In multivariate analysis, TAPSE/PASP and SVI/PASP were independent of other risk strati cation methods including computed tomography-derived RVD, the Bova score, and subjective assessment of TTE-derived RVD. ConclusionIn patients with normotensive acute PE, TTE-derived measures of RV-PA coupling are strongly associated with adverse in-hospital PE-related events and provide incremental value in the risk assessment beyond computed tomography-derived RVD, the Bova score, or subjective TTE-derived RVD.

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The role of echocardiography in pulmonary embolism for the prediction of in-hospital mortality: a retrospective study

Spampinato,

Portoraro,

Sofia

et al. 2024

J Ultrasound

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Purpose Pulmonary Embolism (PE) is the third leading cause of cardiovascular death, following myocardial infarction and stroke. The latest European Society of Cardiology (ESC) guidelines on PE recommend short-term prognostic stratification based on right ventricular (RV) overload detected by transthoracic echocardiography (TTE) or contrast-enhanced chest CT. The aim of the study is to find out which of the signs of right ventricular dysfunction best predicts in-hospital mortality (IHM). Methods This is a monocentric, retrospective study including adult patients admitted from the emergency department with a c-e cCT confirmed diagnosis of PE between January 2018 and December 2022 who underwent a TTE within 48 h. Results 509 patients (median age 76 years [IQR 67–84]) were included, with 7.1% IHM. At univariate analysis, RV/LV ratio > 1 (OR 2.23, 95% CI 1.1–4.5), TAPSE < 17 mm (OR 4.73, 95% CI 2.3–9.8), the D-shape (OR 3.73, 95% CI 1.71–8.14), and LVEF < 35% (OR 5.78, 95% CI 1.72–19.47) resulted significantly correlated with IHM. However, at multivariate analysis including also haemodynamic instability, PESI class > II, and abnormal hs-cTnI levels, only LVEF < 35% (OR 5.46, 95% CI 1.32–22.61) resulted an independent predictor of IHM. Conclusion Despite the recognised role of TTE in the early management of patients with circulatory shock and suspected PE, signs of RV dysfunction have been shown to be poor predictors of IHM, whereas severely reduced LVEF is an independent risk factor for in-hospital death.

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Simultaneous Pulmonary Artery Pressure and Left Ventricle Stroke Volume Assessment Predicts Adverse Events in Patients With Pulmonary Embolism

Cited by 9 publications

References 21 publications

Prognostic value of echocardiography-derived right ventricular dysfunction in haemodynamically stable pulmonary embolism: a systematic review and meta-analysis

Prognostic value of echocardiography-derived right ventricular dysfunction in haemodynamically stable pulmonary embolism: a systematic review and meta-analysis

Ventricular-arterial decoupling is associated with in-hospital adverse events in normotensive pulmonary embolism

The role of echocardiography in pulmonary embolism for the prediction of in-hospital mortality: a retrospective study

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