title: Prevalence of Echocardiography Use in Patients Hospitalized with Confirmed Acute Pulmonary Embolism: A Real-World Observational Multicenter Study.
abstract: BACKGROUND
  Acute pulmonary embolism (PE) carries an increased risk of death. Using transthoracic echocardiography (TTE) to assist diagnosis and risk stratification is recommended in current guidelines. However, its utilization in real-world clinical practice is unknown. We conducted a retrospective observational study to delineate the prevalence of inpatient TTE use following confirmed acute PE, identify predictors for its use and its impact on patient's outcome.
  
  
  METHODS
  Clinical details of consecutive patients (2000 to 2012) from two tertiary-referral hospitals were retrieved from dedicated PE databases. All-cause and cause-specific mortality was tracked from a state-wide death registry.
  
  
  RESULTS
  In total, 2306 patients were admitted with confirmed PE, of whom 687 (29.8%) had inpatient TTE (39.3% vs 14.4% between sites, P<0.001). Site to which patient presented, older age, cardiac failure, atrial fibrillation and diabetes were independent predictors for inpatient TTE use, while malignancy was a negative predictor. Overall mortality was 41.4% (mean follow-up 66.5±49.5months). Though inpatient TTE use was not an independent predictor for all-cause or cardiovascular mortality in multivariable analysis, in the inpatient TTE subgroup, right ventricle-right atrial pressure gradient (hazard ratio [HR] 1.02 per-1mmHg increase, 95% confidence interval [CI] 1.01-1.03) and moderate/severe aortic stenosis (HR 2.26, 95% CI 1.20-4.27) independently predicted all-cause mortality.
  
  
  CONCLUSIONS
  Inpatient TTE is used infrequently in real-world clinical settings following acute PE despite its usefulness in risk stratification, prognostication and assessing comorbid cardiac pathologies. Identifying patients that will benefit most from a TTE assessment following an acute PE episode and reducing barriers in accessing TTE should be explored.
authors.affiliation: Cardiology Department, Concord Hospital, The University of Sydney, Concord, New South Wales, Australia.
authors.forename: Rong
authors.initials: R
authors.lastname: Bing
authors.affiliation: Cardiology Department, Concord Hospital, The University of Sydney, Concord, New South Wales, Australia.
authors.forename: Vincent
authors.initials: V
authors.lastname: Chow
authors.affiliation: Cardiology Department, Concord Hospital, The University of Sydney, Concord, New South Wales, Australia.
authors.forename: Jerrett K
authors.initials: JK
authors.lastname: Lau
authors.affiliation: Cardiology Department, Liverpool Hospital, Sydney South West Clinical School, University of New South Wales, Liverpool, New South Wales, Australia.
authors.forename: Liza
authors.initials: L
authors.lastname: Thomas
authors.affiliation: Cardiology Department, Concord Hospital, The University of Sydney, Concord, New South Wales, Australia.
authors.forename: Leonard
authors.initials: L
authors.lastname: Kritharides
authors.affiliation: Cardiology Department, Concord Hospital, The University of Sydney, Concord, New South Wales, Australia.
authors.forename: Austin Chin Chwan
authors.identifier: http://orcid.org/0000-0002-1317-876X
authors.initials: AC
authors.lastname: Ng
mesh_terms: D000367:Age Factors; D001281:Atrial Fibrillation / Q000150:complications; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D015995:Prevalence; D016016:Proportional Hazards Models; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors