title: Right ventricular echocardiographic parameters are associated with mortality after acute pulmonary embolism.
abstract: BACKGROUND
  There is limited information on the utility of certain echocardiographic measurements, such as right ventricular (RV) strain analysis, in predicting mortality in patients with acute pulmonary embolism (PE).
  
  
  METHODS
  A total of 211 patients with acute PE admitted to a medical intensive care unit (ICU) were retrospectively identified. Echocardiographic variables were prospectively measured in this cohort. The focus was on ICU, hospital, and long-term mortality.
  
  
  RESULTS
  The mean age was 61 ± 15 years. Median Acute Physiology and Chronic Health Evaluation IV and simplified Pulmonary Embolism Severity Index scores were 60 (interquartile range, 40-71) and 2 (interquartile range, 1-2), respectively. Thirty-eight patients (18%) died during the sentinel hospitalization (13% died in the ICU). A total of 61 patients (28.9%) died during a median follow-up period of 15 months (interquartile range, 5-26 months). The echocardiographic variables associated with long-term mortality (from PE diagnosis) were ratio of RV to left ventricular end-diastolic diameter (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.2-4.8), tricuspid annular plane systolic excursion (HR, 0.53; 95% CI, 0.31-0.92), and RV-right atrial gradient (HR, 1.02; 95% CI, 1.01-1.4). ICU mortality was associated with ratio of RV to LV end-diastolic diameter (HR, 4.4; 95% CI, 1.3-15), RV systolic pressure (HR, 1.03; 95% CI, 1.01-1.05), tricuspid annular plane systolic excursion (HR, 0.4; 95% CI, 0.18-0.9), and inferior vena cava collapsibility < 50% (HR, 4.3; 95% CI, 1.7-11). These variables remain significantly associated with mortality after adjusting by Acute Physiology and Chronic Health Evaluation IV score, Pulmonary Embolism Severity Index score, or the use of thrombolytic agents. RV strain parameters were not correlated with hospital or long-term mortality.
  
  
  CONCLUSIONS
  Four simple parameters that measure different aspects of the right ventricle (ratio of RV to left ventricular end-diastolic diameter, RV systolic pressure, tricuspid annular plane systolic excursion, and inferior vena cava collapsibility) were independently associated with mortality in patients presenting with acute PE who were admitted to the ICU.
authors.affiliation: Interventional Pulmonary, Henry Ford Hospital, Detroit, Michigan. Electronic address: danai_md@hotmail.com.
authors.forename: Danai
authors.initials: D
authors.lastname: Khemasuwan
authors.affiliation: Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Teerapat
authors.initials: T
authors.lastname: Yingchoncharoen
authors.affiliation: Pulmonary and Critical Care Medicine, University at Buffalo, Buffalo, New York.
authors.forename: Pichapong
authors.initials: P
authors.lastname: Tunsupon
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Kenya
authors.initials: K
authors.lastname: Kusunose
authors.affiliation: Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Ajit
authors.initials: A
authors.lastname: Moghekar
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Allan
authors.initials: A
authors.lastname: Klein
authors.affiliation: Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Adriano R
authors.initials: AR
authors.lastname: Tonelli
mesh_terms: D000208:Acute Disease; D015984:Causality; D015897:Comorbidity; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000401:mortality*; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D015996:Survival Rate; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000401:mortality*
keywords: Acute pulmonary embolism; Echocardiography; Mortality