Eugene Yuriditsky1, Oscar J L Mitchell2, Akhilesh K Sista3, Yuhe Xia4, Rachel A Sibley5, Judy Zhong4, William H Moore3, Nancy E Amoroso6, Ronald M Goldenberg6, Deane E Smith7, Shari B Brosnahan6, Catherine Jamin8, Thomas S Maldonado9, James M Horowitz10. 1. Division of Cardiology, Department of Medicine, New York University School of Medicine, 530 First Ave. Skirball 9R, New York, NY 10016, United States of America. Electronic address: Eugene.yuriditsky@nyulangone.org. 2. Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, United States of America. 3. Department of Radiology, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America. 4. Division of Biostatistics, Department of Population Health, New York University School of Medicine, 180 Madison Ave, New York, NY 10016, United States of America. 5. Department of Medicine, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America. 6. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America. 7. Division of Cardiac Surgery, Department of Cardiothoracic Surgery, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America. 8. Department of Emergency Medicine, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America. 9. Division of Vascular and Endovascular Surgery, Department of Surgery, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America. 10. Division of Cardiology, Department of Medicine, New York University School of Medicine, 530 First Ave. Skirball 9R, New York, NY 10016, United States of America.
Abstract
PURPOSE: The right ventricular outflow tract (RVOT) velocity time integral (VTI), an echocardiographic measure of stroke distance, correlates with cardiac index. We sought to determine the prognostic significance of low RVOT VTI on clinical outcomes among patients with acute pulmonary embolism (PE). MATERIALS AND METHODS: We conducted a retrospective review of echocardiograms on Pulmonary Embolism Response Team (PERT) activations at our institution. The main outcome was a composite of death, cardiac arrest, or hemodynamic deterioration. RESULTS: Of 188 patients, 30 met the combined outcome (16%) and had significantly lower RVOT VTI measurements (9.0 cm v 13.4 cm, p < 0.0001). The AUC for RVOT VTI at a cutoff of 10 cm was 0.78 (95% CI 0.67-0.90) with a sensitivity, specificity, negative predictive value, and positive predictive value of 0.72, 0.81, 0.94, and 0.42, respectively. Fifty-two patients of the cohort were classified as intermediate-high-risk PE and 21% of those met the combined outcome. RVOT VTI was lower among outcome positive patients (7.3 cm v 10.7 cm, p = 0.02). CONCLUSIONS: Low RVOT VTI is associated with poor clinical outcomes among patients with acute PE.
PURPOSE: The right ventricular outflow tract (RVOT) velocity time integral (VTI), an echocardiographic measure of stroke distance, correlates with cardiac index. We sought to determine the prognostic significance of low RVOT VTI on clinical outcomes among patients with acute pulmonary embolism (PE). MATERIALS AND METHODS: We conducted a retrospective review of echocardiograms on Pulmonary Embolism Response Team (PERT) activations at our institution. The main outcome was a composite of death, cardiac arrest, or hemodynamic deterioration. RESULTS: Of 188 patients, 30 met the combined outcome (16%) and had significantly lower RVOT VTI measurements (9.0 cm v 13.4 cm, p < 0.0001). The AUC for RVOT VTI at a cutoff of 10 cm was 0.78 (95% CI 0.67-0.90) with a sensitivity, specificity, negative predictive value, and positive predictive value of 0.72, 0.81, 0.94, and 0.42, respectively. Fifty-two patients of the cohort were classified as intermediate-high-risk PE and 21% of those met the combined outcome. RVOT VTI was lower among outcome positive patients (7.3 cm v 10.7 cm, p = 0.02). CONCLUSIONS: Low RVOT VTI is associated with poor clinical outcomes among patients with acute PE.