Short-Term Clinical Outcome of Patients With Acute Pulmonary Embolism, Normal Blood Pressure, and Echocardiographic Right Ventricular Dysfunction

Abstract

A significant proportion (31%) of normotensive patients with acute PE presents with RV dysfunction; these patients with latent hemodynamic impairment have a 10% rate of PE-related shock and 5% in-hospital mortality and may require aggressive therapeutic strategies. Conversely, normotensive patients without echocardiographic RV dysfunction have a benign short-term prognosis. Thus, early detection of echocardiographic RV dysfunction is of major importance in the risk stratification of normotensive patients with acute PE.

Usefulness of Combined Assessment With Computed Tomographic Signs of Right Ventricular Dysfunction and Cardiac Troponin T for Risk Stratification of Acute Pulmonary Embolism

“…In comparison, patients with no RV dysfunction on echocardiography had excellent outcomes; the reported mortality was lower, at approximately 1% to 2%. 10,11,20,21 In the present study, the early death rate was higher in patients with RVD/LVD ratios Ͼ1.1 or RVV/LVV ratios Ͼ1.5 compared to those with negative findings ( Figure 2). Thus, the RVD/LVD ratio or RVV/LVV ratio could predict early death or adverse outcomes.…”

Thrombolysis Compared With Heparin for the Initial Treatment of Pulmonary Embolism

“…Patients at risk of dying of major pulmonary embolism are also those most likely to achieve benefit from thrombolytic therapy, because more rapid clot lysis can reverse hypotension and prevent irreversible shock that leads to death. Registry data indicate that right ventricular dysfunction in patients with acute pulmonary embolism is associated with an increased risk of fatal outcomes, 3,55 even in patients who are hemodynamically stable, 4 and it is therefore plausible that these patients would derive benefit from thrombolytic therapy compared with heparin. Unfortunately, the majority of trials included in the present meta-analysis did not separately report the proportion of patients with right ventricular dysfunction without hemodynamic instability, and we were therefore unable to further explore this question.…”

Right Ventricular Enlargement on Chest Computed Tomography

“…[12][13][14][15] However, echocardiography has limited availability at many institutions, and, occasionally, the RV may be difficult to image with the transthoracic approach.…”