Michele Domenico Spampinato, Andrea Portoraro, Soccorsa M Sofia, Francesco Luppi, Marcello Benedetto, Luca D'Angelo, Giorgio Galizia, Irma Sofia Fabbri, Teresa Pagano, Benedetta Perna, Matteo Guarino, Giulia Passarini, Rita Pavasini, Angelina Passaro, Roberto De Giorgio
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引用次数: 0
Abstract
Purpose: Pulmonary Embolism (PE) is the third leading cause of cardiovascular death, following myocardial infarction and stroke. The latest European Society of Cardiology (ESC) guidelines on PE recommend short-term prognostic stratification based on right ventricular (RV) overload detected by transthoracic echocardiography (TTE) or contrast-enhanced chest CT. The aim of the study is to find out which of the signs of right ventricular dysfunction best predicts in-hospital mortality (IHM).
Methods: This is a monocentric, retrospective study including adult patients admitted from the emergency department with a c-e cCT confirmed diagnosis of PE between January 2018 and December 2022 who underwent a TTE within 48 h.
Results: 509 patients (median age 76 years [IQR 67-84]) were included, with 7.1% IHM. At univariate analysis, RV/LV ratio > 1 (OR 2.23, 95% CI 1.1-4.5), TAPSE < 17 mm (OR 4.73, 95% CI 2.3-9.8), the D-shape (OR 3.73, 95% CI 1.71-8.14), and LVEF < 35% (OR 5.78, 95% CI 1.72-19.47) resulted significantly correlated with IHM. However, at multivariate analysis including also haemodynamic instability, PESI class > II, and abnormal hs-cTnI levels, only LVEF < 35% (OR 5.46, 95% CI 1.32-22.61) resulted an independent predictor of IHM.
Conclusion: Despite the recognised role of TTE in the early management of patients with circulatory shock and suspected PE, signs of RV dysfunction have been shown to be poor predictors of IHM, whereas severely reduced LVEF is an independent risk factor for in-hospital death.
期刊介绍:
The Journal of Ultrasound is the official journal of the Italian Society for Ultrasound in Medicine and Biology (SIUMB). The journal publishes original contributions (research and review articles, case reports, technical reports and letters to the editor) on significant advances in clinical diagnostic, interventional and therapeutic applications, clinical techniques, the physics, engineering and technology of ultrasound in medicine and biology, and in cross-sectional diagnostic imaging. The official language of Journal of Ultrasound is English.