title: Echocardiography does not predict mortality in hemodynamically stable elderly patients with acute pulmonary embolism.
abstract: BACKGROUND
  The evidence on the prognostic value of transthoracic echocardiography (TTE) in elderly, hemodynamically stable patients with Pulmonary Embolism (PE) is limited.
  
  
  OBJECTIVE
  To evaluate the prevalence of common echocardiographic signs of right ventricular (RV) dysfunction and their prognostic impact in hemodynamically stable patients aged ≥65years with acute PE in a prospective multicenter cohort.
  
  
  METHODS
  TTE was performed by cardiologists. We defined RV dysfunction as a RV/left ventricular ratio >0.9 or RV hypokinesis (primary definition) or the presence of ≥1 or ≥2 of 6 predefined echocardiographic signs (secondary definitions). Outcomes were overall mortality and mortality/non-fatal recurrent venous thromboembolism (VTE) at 30days, adjusting for the Pulmonary Embolism Severity Index risk score and highly sensitive troponin T values.
  
  
  RESULTS
  Of 400 patients, 36% had RV dysfunction based on our primary definition, and 81% (≥1 sign) and 53% (≥2 signs) based on our secondary definitions, respectively. Using our primary definition, there was no association between RV dysfunction and mortality (adjusted HR 0.90, 95% CI 0.31-2.58) and mortality/non-fatal VTE (adjusted HR 1.09, 95% CI 0.40-2.98). Similarly, there was no statistically significant association between the presence of ≥1 or ≥2 echocardiographic signs (secondary definitions) and clinical outcomes.
  
  
  CONCLUSIONS
  The prevalence of echocardiographic RV dysfunction varied widely depending upon the definition used. There was no association between RV dysfunction and clinical outcomes. Thus, TTE may not be suitable as a stand-alone risk assessment tool in elderly patients with acute PE.
  
  
  BACKGROUND
  http://clinicaltrials.gov. Identifier: NCT00973596.
authors: Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland. Electronic address: eveline.hofmann@insel.ch.
authors: Eveline
authors: E
authors: Hofmann
authors: Clinical Trials Unit Bern, Department of Clinical Research, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors: Andreas
authors: A
authors: Limacher
authors: Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland; Department of General Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
authors: Marie
authors: M
authors: Méan
authors: Division of Angiology, Bern University Hospital, Bern, Switzerland.
authors: Nils
authors: N
authors: Kucher
authors: Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland.
authors: Marc
authors: M
authors: Righini
authors: Department of Internal Medicine, Cantonal Hospital of Frauenfeld, Frauenfeld, Switzerland.
authors: Beat
authors: B
authors: Frauchiger
authors: Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland.
authors: Jürg-Hans
authors: JH
authors: Beer
authors: Emergency Department, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland.
authors: Joseph
authors: J
authors: Osterwalder
authors: Division of Angiology, Basel University Hospital, Basel, Switzerland.
authors: Markus
authors: M
authors: Aschwanden
authors: Cardiovascular Research, Institute of Physiology, Zurich Center for Integrative Human Physiology, University of Zurich, and Division of Cardiology, Zurich University Hospital, Zurich, Switzerland.
authors: Christian M
authors: CM
authors: Matter
authors: Division of Angiology, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
authors: Martin
authors: M
authors: Banyai
authors: Department of Endocrinology, Diabetes, Hypertension and Nutrition, Geneva University Hospital, Geneva, Switzerland.
authors: Michael
authors: M
authors: Egloff
authors: Emergency Department, Lausanne University Hospital, Lausanne, Switzerland.
authors: Olivier
authors: O
authors: Hugli
authors: Division of Angiology, Basel University Hospital, Basel, Switzerland.
authors: Daniel
authors: D
authors: Staub
authors: Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland.
authors: Henri
authors: H
authors: Bounameaux
authors: Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland; Institute of Primary Health Care, University of Bern, Bern, Switzerland.
authors: Nicolas
authors: N
authors: Rodondi
authors: Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
authors: Drahomir
authors: D
authors: Aujesky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000401:mortality; D016896:Treatment Outcome
keywords: Echocardiography; Mortality; Pulmonary embolism