Right Ventricular Echocardiographic Parameters Predict Mortality After Acute Pulmonary Embolism

Abstract

SESSION TITLE: Critical Care Posters IISESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: Velocity vector imaging (VVI) has been used to evaluate right ventricular (RV) strain pattern in patients with pulmonary artery hypertension. However, there is limited information on the utility of VVI and modern echocardiographic measurements (e.g. RV/LV end diastolic ratio, Tricuspid annular plane systolic excursion (TASPE), etc.) in predicting ICU and long-term mortality in acute pulmonary embolism (PE). METHODS: We identified patients with acute PE admitted to Cleveland Clinic between March 2009 and January 2013. We included 211 patients with acute PE in this cohort. Hemodynamic instability was defined as hypotension or need of vasopressors at admission. A large number of traditional and modern echocardiographic variables of RV were measured (RV outflow tract diameter, RV diastolic diameter, RV/LV end diastolic ratio, TASPE, RV systolic pressure (RVSP), Peak myocardial velocity, RV strain value and strain rate, etc.). Cox regression adjusted by age and gender was used to identify echocardiographic predictors of mortality. Appropriate results were adjusted by the simplified PESI (Pulmonary Embolism Severity Index) and APACHE score. Results are given as hazard ratio (HR) and 95% confidence interval. RESULTS: The mean (+/- SD) age was 61+/-15 years (51 % females). Median (IQR) APACHE III and PESI score were 60 (40-78) and 2 (1-2). A total of 61 (28.9%) patients died during a median (IQR) follow-up of 15 (5-26) months and 38 (18%) died during the sentinel hospitalization (of these 28 (13%) died in the MICU). Hemodynamic instability was observed in 48 (23%) patients. Variables associated with overall mortality during follow-up were ratio of right to left end diastolic diameter (RV/LVEDD) (HR: 2.4 [1.2-4.8]), TAPSE (HR: 0.53[0.31-0.92]), and RV/A gradient (HR: 1.02 [1.01-1.4]). ICU mortality was associated with RV/LVEDD (HR: 4.4 [1.3-15]), RVSP (HR: 1.03 [1.01-1.05]), TAPSE (HR: 0.4 [0.18-0.9]), IVC collapsibility < 50% (HR: 4.3 [1.7-11]). These variables remain statistically significant to predict mortality even after adjusting them by PESI score, APACHE or use of thrombolytics. RV strain parameters did not correlate with hospital or long-term mortality. CONCLUSIONS: Four simple parameters that determine function of the right ventricle (RV/LVEDD ratio, RVSP, TAPSE, and IVC collapsibility < 50%) were related to ICU mortality in patients presenting with acute PE. CLINICAL IMPLICATIONS: We identified simple echocardiographic parameters that predicted ICU and in-hospital mortality in patients presenting with acute PE. DISCLOSURE: The following authors have nothing to disclose: Danai Khemasuwan, Teerapat Yingchoncharoen, Pichapong Tunsupon, Kenya Kusunose, Allan Klein, Ajit Moghekar, Adriano TonelliNo Product/Research Disclosure Information.