title: Echocardiography and pulmonary embolism severity index have independent prognostic roles in pulmonary embolism.
abstract: We analysed a cohort of patients with normotensive pulmonary embolism (PE) in order to assess whether combining echocardiography and biomarkers with the pulmonary embolism severity index (PESI) improves the risk stratification in comparison to the PESI alone. The PESI was calculated in normotensive patients with PE who also underwent echocardiography and assays of cardiac troponin I and brain natriuretic peptide. 30-day adverse outcome was defined as death, recurrent PE or shock. 529 patients were included, 25 (4.7%, 95% CI 3.2-6.9%) had at least one outcome event. The proportion of patients with adverse events increased from 2.1% in PESI class I-II to 8.4% in PESI class III-IV, and to 14.3% in PESI class V (p<0.001). In PESI class I-II, the rate of outcome events was significantly higher in patients with abnormal values of biomarkers or right ventricular dilatation. In multivariate analysis, the PESI (class III-IV versus I-II, OR 3.1, 95% CI 1.2-8.3; class V versus I-II, OR 5.5, 95% CI 1.5-25.5 and echocardiography (right ventricular/left ventricular ratio, OR (for an increase of 0.1) 1.3, 95% CI 1.1-1.5) were independent predictors of an adverse outcome. In patients with normotensive PE, biomarkers and echocardiography provided additional prognostic information to the PESI.
authors.affiliation: Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Pneumologie et Soins Intensifs, INSERM U 765, Paris, France. olivier.sanchez@egp.aphp.fr
authors.forename: Olivier
authors.initials: O
authors.lastname: Sanchez
authors.forename: Ludovic
authors.initials: L
authors.lastname: Trinquart
authors.forename: Benjamin
authors.initials: B
authors.lastname: Planquette
authors.forename: Francis
authors.initials: F
authors.lastname: Couturaud
authors.forename: Franck
authors.initials: F
authors.lastname: Verschuren
authors.forename: Vincent
authors.initials: V
authors.lastname: Caille
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meneveau
authors.forename: Gérard
authors.initials: G
authors.lastname: Pacouret
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Roy
authors.forename: Marc
authors.initials: M
authors.lastname: Righini
authors.forename: Arnaud
authors.initials: A
authors.lastname: Perrier
authors.forename: Laurent
authors.initials: L
authors.lastname: Bertoletti
authors.forename: Florence
authors.initials: F
authors.lastname: Parent
authors.forename: Christine
authors.initials: C
authors.lastname: Lorut
authors.forename: Guy
authors.initials: G
authors.lastname: Meyer
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000209:etiology; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I; D020097:Natriuretic Peptide, Brain