Echocardiography does not predict mortality in hemodynamically stable elderly patients with acute pulmonary embolism

Hofmann, Eveline; Limacher, Andreas; Méan, Marie; Kucher, Nils; Righini, Marc; Frauchiger, Beat; Beer, Jürg H.; Österwalder, Joseph; Aschwanden, Markus; Matter, Christian M.; Borggrefe, Martin; Egloff, Michaël; Staub, Daniel; Bounameaux, Henri; Rodondi, Nicolas; Aujesky, Drahomir

doi:10.1016/j.thromres.2016.07.014

Cited by 13 publications

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“…In our study, each of the 3 studied TTE findings was associated with 30‐day PE‐related mortality in unadjusted and adjusted models. A study of 529 patients with PE identified separate effects of PESI and TTE findings on 30‐day outcomes of patients with PE,3 while another recent study of 400 patients with PE by Hofmann et al did not find an independent association between TTE findings and outcomes 5. The association between RA enlargement and PE outcomes has been under recent investigation,13, 14 and may be potentially explained by right heart volume and pressure overload in the setting of acute PE.…”

Section: Discussionmentioning

confidence: 97%

“…Some studies suggest that transthoracic echocardiography (TTE) could help in early risk stratification of patients with acute PE. Yet, the results have been inconsistent and the use of TTE in real life and its prognostic value have not been consistently studied 3, 4, 5, 6. We used the data from the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry to report the real‐world use and predictors of early TTE (within the first 72 hours from diagnosis) in patients with PE, and to explore the association between some of the main TTE findings and 30‐day PE‐related mortality in unadjusted and adjusted analyses.…”

Section: Introductionmentioning

confidence: 99%

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Early Use of Echocardiography in Patients With Acute Pulmonary Embolism: Findings From the RIETE Registry

Bikdeli

Lobo

Jiménez

et al. 2018

JAHA

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BackgroundTransthoracic echocardiography (TTE) is often considered for risk stratification of patients with acute pulmonary embolism (PE). We sought to determine the contemporary utilization of early TTE (within 72 hours of PE diagnosis) and explored the association between TTE findings and PE‐related mortality.Methods and ResultsData from the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry, a multicenter registry of consecutive patients with acute PE, were used (2001–July 2017). We used a generalized linear mixed model to determine predictors of early TTE performance. Moreover, the association between 3 TTE variables (right atrial enlargement, right ventricular hypokinesis, and presence of right heart thrombi) and 30‐day PE‐related mortality was assessed in generalized linear mixed models adjusted for PE severity index, and other comorbidities. Among 35 935 enrollees with acute PE, 15 375 (42.8%) underwent early TTE. There was an increase in early TTE utilization rate over time (P<0.001 for trend). Younger age, female sex, enrollment in countries other than Spain, history of coronary disease, heart failure, atrial fibrillation, tachycardia, and hypotension were the main predictors of early TTE (P<0.01 for all). In multivariable analyses, right atrial enlargement (adjusted odds ratio: 3.74; 95% confidence interval, 2.10–6.66), right ventricular hypokinesis (adjusted odds ratio: 3.11, 95% confidence interval: 1.85–5.21) and right heart thrombi (adjusted odds ratio: 4.39, 95% confidence interval, 1.99–9.71) were associated with increased odds for PE‐related mortality.ConclusionsEarly TTE is commonly performed for acute PE and utilization rates have increased over time. Right atrial enlargement, right ventricular hypokinesis, and right heart thrombi are predictive of worse outcomes.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02832245.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Early Use of Echocardiography in Patients With Acute Pulmonary Embolism: Findings From the RIETE Registry

Bikdeli

Lobo

Jiménez

et al. 2018

JAHA

Self Cite

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“…A meta-analysis done on 3,395 patients admitted with PE revealed a twofold increase in mortality, but sub-analysis on normotensive patients correlated poorly with mortality [13]. Similar results were seen in a study done in 400 patients older than 65 years of age, which showed that RVD in APE was not associated with poor outcomes [12]. Our study supports these findings that normotensive patients with APE are not at increased risk for 30-day mortality, although hemodynamic instability with RVD is associated with increased mortality.…”

Section: Discussionmentioning

confidence: 58%

“…The prevalence of RVD varies from 30% to 80% depending on the definition used [12]. The lack of standard criteria is the reason for the wide variability.…”

Section: Discussionmentioning

confidence: 99%

“…Though these patients are usually treated with anticoagulation alone, guidelines suggest considering treatment of some high-risk patients with submassive PE with evidence of RVD with systemic fibrinolysis [10, 11]. Some studies also show no difference in mortality and recommend against using any systemic thrombolysis in these hemodynamically stable patients [12]. …”

Section: Introductionmentioning

confidence: 99%

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Does Right Ventricular Dysfunction Predict Mortality in Hemodynamically Stable Patients With Acute Pulmonary Embolism?

et al. 2017

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BackgroundAcute pulmonary embolism (APE) is directly responsible for 100,000 deaths annually. Right ventricular dysfunction (RVD) on admission is considered a poor prognostic factor in these patients, though existing evidence of its significance in predicting mortality in hemodynamically stable patients is still unclear. We attempted to clarify this association by doing a retrospective review.MethodsWe retrospectively reviewed electronic medical records of hemodynamically stable patients older than 18 years of age with APE who were admitted to a tertiary care hospital in rural Upstate New York from July 2014 to July 2016. One hundred thirty-four patients were reviewed in two groups: patients who presented with computed tomography (CT) or echocardiographic evidence of RVD, and those without RVD. To identify differences in mortality between the two groups, the Chi-square/Fisher’s exact test and t-tests were used. All variables with P < 0.2 in the initial analysis were included in a stepwise multivariable logistic regression model to predict RVD.ResultsNo statistically significant difference was found in 30-day mortality between the groups (7.8% in RVD and 5.3% in no RVD, P = 0.563). The overall prevalence of RVD was found to be 57% (77/134). Troponin elevation (53.2% in RVD group vs. 19.3 in the no RVD group with P < 0.01) and central location of thrombus (53.1% vs. 32.1% with P = 0.016) were more prevalent in RVD group. A marginally significant difference was found in length of hospital stay among those with RVD versus no RVD (7.13 days vs. 5.46 days; P = 0.061). The multivariable analysis shows that the odds of RVD were greater for patients with elevated troponin levels (odds ratio = 7.8).ConclusionThere was no difference in 30-day mortality in hemodynamically stable patients with APE having RVD compared to patients with no RVD. On the basis of this study, we do not suggest the routine use of systemic fibrinolysis in hemodynamically stable patients with radiographic evidence of RVD alone.

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Differences in clinical and echocardiographic variables and mortality predictors among older patients with pulmonary embolism

et al. 2021

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Echocardiography does not predict mortality in hemodynamically stable elderly patients with acute pulmonary embolism

Abstract: Background:The evidence on the prognostic value of transthoracic

Cited by 13 publications

References 33 publications

Early Use of Echocardiography in Patients With Acute Pulmonary Embolism: Findings From the RIETE Registry

Early Use of Echocardiography in Patients With Acute Pulmonary Embolism: Findings From the RIETE Registry

Does Right Ventricular Dysfunction Predict Mortality in Hemodynamically Stable Patients With Acute Pulmonary Embolism?

Differences in clinical and echocardiographic variables and mortality predictors among older patients with pulmonary embolism

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