Echocardiographic predictors of mortality in intermediate-risk pulmonary embolism

Falsetti, Lorenzo; Marra, Alberto M.; Zaccone, Vincenzo; Sampaolesi, Mattia; Riccomi, Francesca; Giovenali, Laura; Guerrieri, Emanuele; Viticchi, Giovanna; D’Agostino, Anna; Gentili, T.; Nitti, Cinzia; Moroncini, Gianluca; Cittadini, Antonio; Salvi, Aldo

doi:10.1007/s11739-021-02910-w

Cited by 12 publications

(12 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is because all-cause mortality is less related to the underlying pathophysiologic mechanism of mortality in PE and is therefore likely of less suitable outcome than PE-related mortality when evaluating echocardiographic measurements. However, our event rates are similar to other unselected PE populations assessing RV-PA coupling such as Ciurzyński et al where 8/400 (2%) PE-related death or hemodynamic decompensation [7] and Falsetti et al where 10/256 (3.9%) had in-hospital mortality [10]. Data collection was retrospective and some TTE parameters were unavailable as they were not recorded routinely but at the discretion of the echocardiography technologist.…”

Section: Discussionsupporting

confidence: 82%

“…who reported that only 270/326 (83%) patients had complete data [9,10]. Lastly, because performing a TTE was at the discretion of the attending physician, there have been some selection bias in this cohort (only 820/2067 patients had a TTE within 48 hours of diagnosis).…”

Section: Discussionmentioning

confidence: 95%

“…Current international guidelines on the diagnosis and management of PE recommend consideration of transthoracic echocardiography (TTE) for risk strati cation although there are no standardized echocardiographic measures to de ne the presence or absence of RVD [6]. The prognostic importance of TTE-derived RV-PA coupling indices such as tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) and stroke volume/PASP have been recently reported [7][8][9][10]. However, questions regarding the role of RV-PA coupling in PE still exist.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Ventricular-arterial decoupling is associated with in-hospital adverse events in normotensive pulmonary embolism

Kiamanesh

Prosperi-Porta

Harper

et al. 2022

Int J Cardiovasc Imaging

View full text Add to dashboard Cite

During acute pulmonary embolism (PE) a compensatory increase in right ventricular (RV) contractility is required to match increased afterload to maintain right ventricular-pulmonary arterial (RV-PA) coupling. The aim of this study was to assess the prognostic utility of RV-PA decoupling in acute PE. MethodsWe assessed the association between measures of transthoracic echocardiography (TTE)-derived RV-PA coupling including tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) and right ventricular fractional area change (FAC)/PASP as well as stroke volume index (SVI)/PASP (a measure of pulmonary artery capacitance) with adverse PE-related events (in-hospital PErelated mortality or cardiopulmonary decompensation) using logistic regression analysis. ResultsIn 820 normotensive patients TTE-derived markers of RV-PA coupling were associated with PE-related adverse events. For each 0.1mm/mmHg decrease in TAPSE/PASP the odds of an adverse event increased by 2.5-fold (adjusted OR (aOR) 2.49, 95% con dence interval (CI) 1.46-4.24, p = 0.001), for every 0.1%/mmHg decrease in FAC/PASP the odds of an adverse event increased by 1.4-fold (aOR 1.42, CI 1.09-1.86, p = 0.010), and for every 0.1mL/mmHg•m 2 decrease in SVI/PASP the odds of an event increased by 2.75-fold (aOR 2.78, CI 1.72-4.50, p < 0.001). In multivariate analysis, TAPSE/PASP and SVI/PASP were independent of other risk strati cation methods including computed tomography-derived RVD, the Bova score, and subjective assessment of TTE-derived RVD. ConclusionIn patients with normotensive acute PE, TTE-derived measures of RV-PA coupling are strongly associated with adverse in-hospital PE-related events and provide incremental value in the risk assessment beyond computed tomography-derived RVD, the Bova score, or subjective TTE-derived RVD.

show abstract

Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Ventricular-arterial decoupling is associated with in-hospital adverse events in normotensive pulmonary embolism

Kiamanesh

Prosperi-Porta

Harper

et al. 2022

Int J Cardiovasc Imaging

View full text Add to dashboard Cite

show abstract

“…Bedside assessment also allows the non-cardiologist to perform an accurate differential diagnosis, an instrumental follow-up to assess treatment response, and a functional and prognostic appraisal [ 22 , 23 ]. This technique requires a specific training [ 24 ], and it is widely used in the ED to assess critical conditions as acute heart failure [ 23 , 25 ], pulmonary embolism [ 26 , 27 , 28 ], pericardial effusion [ 29 , 30 ], and shock states [ 31 ]. In the setting of AHF, bedside echocardiography allows medical staff to obtain reliable information regarding LVEF, right ventricle function, tricuspid regurgitant velocity, diastolic dysfunction, and atrial volumes [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Improving the EHMRG Prognostic Evaluation of Acute Heart Failure with TAPSE/PASp: A Sequential Approach

et al. 2022

Self Cite

View full text Add to dashboard Cite

The Emergency Heart Failure Mortality Risk Grade (EHMRG) can predict short-term mortality in patients admitted for acute heart failure (AHF) in the emergency department (ED). This paper aimed to evaluate if TAPSE/PASp, an echocardiographic marker of ventricular desynchronization, can improve in-hospital death prediction in patients at moderate-to-high risk, according to EHMRG score classification. From 1 January 2018 to 30 December 2019, we retrospectively enrolled all the consecutive subjects admitted to our Internal Medicine Department for AHF from the ED. We performed bedside echocardiography within the first 24 h of admission. We evaluated EHMRG and NYHA in the ED, days of admission in Internal Medicine, and in-hospital mortality. We assessed cutoffs with ROC curve analysis and survival with Kaplan–Meier and Cox regression. We obtained a cohort of 439 subjects; 10.3% underwent in-hospital death. Patients with normal TAPSE/PASp in EHMRG Classes 4, 5a, and 5b had higher survival rates (100%, 100%, and 94.3%, respectively), while subjects with pathologic TAPSE/PASp had lower survival rates (81.8%, 78.3%, and 43.4%, respectively) (p < 0.0001, log-rank test). TAPSE/PASp, an echocardiographic marker of ventricular desynchronization, can further stratify the risk of in-hospital death evaluated by EHMRG.

show abstract

“…Various parameters other than RV dilation have been proposed for a more precise evaluation of RV dysfunction on echocardiography and their prognostic implications have been a subject of numerous publications. Among them, we can cite right atrial enlargement (RAE), tricuspid annulus plane excursion (TAPSE) <18 mm, interventricular septal flattening, time-velocity integral at left-ventricular outflow tract (VTILVOT), and lack of IVC collapsibility [5,7]. In the same line, in their retrospective study of 665 intermediate-risk patients with a sPESI of ≥1, Prosperi-porta et al [8] found that the stroke volume index (SVI) was strongly and independently associated with PE-related death or cardiopulmonary decompensation within 30 days.…”

Section: Assessment Of Right Ventricular Dysfunction On Echocardiogra...mentioning

confidence: 99%

Risk stratification and treatment of pulmonary embolism with intermediate-risk of mortality

Pastré

Sanchis-Borja

Benlounes

2022

Current Opinion in Pulmonary Medicine

View full text Add to dashboard Cite

Purpose of reviewIntermediate-risk pulmonary embolisms (PE) represent a heterogeneous group at the high end of hemodynamically stable patients, characterized by a higher mortality rate. This challenging population gathers many unsolved question regarding its therapeutic management. The purpose of this review is to provide an updated overview of the literature regarding further risk stratification and treatment options in this population.Recent findingsIf anticoagulation represents the undisputed first line of treatment, some patients especially in the intermediate-high risk subgroup may necessitate or could benefit from therapeutic escalation with reperfusion therapies. This includes systemic thrombolysis (ST) or catheter-directed therapies (CDT). ST, despite its high efficacy, is not recommended in this population because of prohibitive bleeding complications. Therefore, reduced-dose ST appears to be a promising option and is actually under evaluation. CDT are percutaneous reperfusion techniques developed to acutely decrease pulmonary vascular obstruction with lower-dose or no thrombolytic agents and, thus, potentially improved safety compared to ST.SummaryGreat progress has been made in the recent years providing a wide range of therapeutic options. Optimal selection of patients who could benefit from these treatments is the key and is based on clinical, biological and radiological parameters evaluating right ventricle function and allowing accurate risk stratification. Pulmonary Embolism Response Team represents an efficient modality for therapeutic management especially in the intermediate-high risk subgroup.

show abstract

Echocardiographic predictors of mortality in intermediate-risk pulmonary embolism

Cited by 12 publications

References 44 publications

Ventricular-arterial decoupling is associated with in-hospital adverse events in normotensive pulmonary embolism

Ventricular-arterial decoupling is associated with in-hospital adverse events in normotensive pulmonary embolism

Improving the EHMRG Prognostic Evaluation of Acute Heart Failure with TAPSE/PASp: A Sequential Approach

Risk stratification and treatment of pulmonary embolism with intermediate-risk of mortality

Contact Info

Product

Resources

About