title: Assessment of right ventricular function in acute pulmonary embolism.
abstract: The optimal approach to assess right ventricular (RV) function in patients with acute symptomatic pulmonary embolism (PE) lacks clarity.
  
  
  METHODS
  This study aimed to evaluate the optimal approach to assess RV function in normotensive patients with acute symptomatic PE. Outcomes assessed through 30-days after the diagnosis of PE included all-cause mortality and complicated course.
  
  
  RESULTS
  Eight hundred forty-eight patients were enrolled. Multidetector computed tomography (MDCT) and transthoracic echocardiography agreed on the presence or absence of RV overload in 449 (53%) patients. The combination of the simplified Pulmonary Embolism Severity Index (sPESI) and MDCT showed a negative predictive value for 30-day all-cause mortality of 100%. Of the 43% that had an sPESI of >0 points and MDCT RV enlargement, 41 (11.3%) experienced a complicated course that included 24 (6.6%) deaths. One hundred twenty-nine patients (15%) had an sPESI of >0 points, MDCT, and echocardiographic RV overload. Of these, 21 (16.3%) experienced a complicated course within the first 30days, and 10 (7.7%) of them died.
  
  
  CONCLUSIONS
  Incorporation of echocardiographic RV overload to the sPESI and MDCT did not improve identification of low-risk PE patients, whereas it improved identification of those at intermediate-high risk for short-term complications.
authors.affiliation: Respiratory Department, Ramón y Cajal Hospital and Universidad de Alcalá IRYCIS, Madrid, Spain.
authors.forename: Deisy
authors.initials: D
authors.lastname: Barrios
authors.affiliation: Respiratory Department, Ramón y Cajal Hospital and Universidad de Alcalá IRYCIS, Madrid, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Morillo
authors.affiliation: Respiratory Department, Hospital Universitario Araba, Álava, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Lobo
authors.affiliation: Respiratory Department, Ramón y Cajal Hospital and Universidad de Alcalá IRYCIS, Madrid, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Nieto
authors.affiliation: Respiratory Department, Ramón y Cajal Hospital and Universidad de Alcalá IRYCIS, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Jaureguizar
authors.affiliation: Department of Internal Medicine, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain.
authors.forename: Ana K
authors.initials: AK
authors.lastname: Portillo
authors.affiliation: Respiratory Department, Ramón y Cajal Hospital and Universidad de Alcalá IRYCIS, Madrid, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Barbero
authors.affiliation: Cardiology Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain.
authors.forename: Covadonga
authors.initials: C
authors.lastname: Fernandez-Golfin
authors.affiliation: Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St Louis, MO.
authors.forename: Roger D
authors.initials: RD
authors.lastname: Yusen
authors.affiliation: Respiratory Department, Ramón y Cajal Hospital and Universidad de Alcalá IRYCIS, Madrid, Spain. Electronic address: djimenez.hrc@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Jiménez
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015897:Comorbidity; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D061330:Multidetector Computed Tomography; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D011655:Pulmonary Embolism / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D018570:Risk Assessment; D012720:Severity of Illness Index; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D016278:Ventricular Function, Right