Deisy Barrios1, Raquel Morillo1, José Luis Lobo2, Rosa Nieto1, Ana Jaureguizar1, Ana K Portillo3, Esther Barbero1, Covadonga Fernandez-Golfin4, Roger D Yusen5, David Jiménez6. 1. Respiratory Department, Ramón y Cajal Hospital and Universidad de Alcalá IRYCIS, Madrid, Spain. 2. Respiratory Department, Hospital Universitario Araba, Álava, Spain. 3. Department of Internal Medicine, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain. 4. Cardiology Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain. 5. Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St Louis, MO. 6. Respiratory Department, Ramón y Cajal Hospital and Universidad de Alcalá IRYCIS, Madrid, Spain. Electronic address: djimenez.hrc@gmail.com.
Abstract
The optimal approach to assess right ventricular (RV) function in patients with acute symptomatic pulmonary embolism (PE) lacks clarity. METHODS: This study aimed to evaluate the optimal approach to assess RV function in normotensive patients with acute symptomatic PE. Outcomes assessed through 30-days after the diagnosis of PE included all-cause mortality and complicated course. RESULTS: Eight hundred forty-eight patients were enrolled. Multidetector computed tomography (MDCT) and transthoracic echocardiography agreed on the presence or absence of RV overload in 449 (53%) patients. The combination of the simplified Pulmonary Embolism Severity Index (sPESI) and MDCT showed a negative predictive value for 30-day all-cause mortality of 100%. Of the 43% that had an sPESI of >0 points and MDCT RV enlargement, 41 (11.3%) experienced a complicated course that included 24 (6.6%) deaths. One hundred twenty-nine patients (15%) had an sPESI of >0 points, MDCT, and echocardiographic RV overload. Of these, 21 (16.3%) experienced a complicated course within the first 30days, and 10 (7.7%) of them died. CONCLUSIONS: Incorporation of echocardiographic RV overload to the sPESI and MDCT did not improve identification of low-risk PE patients, whereas it improved identification of those at intermediate-high risk for short-term complications.
The optimal approach to assess right ventricular (RV) function in patients with acute symptomatic pulmonary embolism (PE) lacks clarity. METHODS: This study aimed to evaluate the optimal approach to assess RV function in normotensive patients with acute symptomatic PE. Outcomes assessed through 30-days after the diagnosis of PE included all-cause mortality and complicated course. RESULTS: Eight hundred forty-eight patients were enrolled. Multidetector computed tomography (MDCT) and transthoracic echocardiography agreed on the presence or absence of RV overload in 449 (53%) patients. The combination of the simplified Pulmonary Embolism Severity Index (sPESI) and MDCT showed a negative predictive value for 30-day all-cause mortality of 100%. Of the 43% that had an sPESI of >0 points and MDCT RV enlargement, 41 (11.3%) experienced a complicated course that included 24 (6.6%) deaths. One hundred twenty-nine patients (15%) had an sPESI of >0 points, MDCT, and echocardiographic RV overload. Of these, 21 (16.3%) experienced a complicated course within the first 30days, and 10 (7.7%) of them died. CONCLUSIONS: Incorporation of echocardiographic RV overload to the sPESI and MDCT did not improve identification of low-risk PE patients, whereas it improved identification of those at intermediate-high risk for short-term complications.
Authors: Kevin Solverson; Christopher Humphreys; Zhiying Liang; Graeme Prosperi-Porta; James E Andruchow; Paul Boiteau; Andre Ferland; Eric Herget; Doug Helmersen; Jason Weatherald Journal: ERJ Open Res Date: 2021-04-19
Authors: Dominik J Vogel; Ambra Fabbri; Andrea Falvo; Jonah Powell-Tuck; Nishita Desai; Francesco Vasques; Chris Meadows; Nicholas Ioannou; Guy Glover; Aimée Brame; Peter Sherren; Andrew Retter; Ronak Rajani; Luigi Camporota Journal: Crit Care Explor Date: 2021-02-22