Prognostic value of right ventricular dysfunction in patients with acute pulmonary embolism and normal blood pressure

Introduction

The role of echocardiographic right ventricular (RV) dysfunction in predicting clinical outcome in clinically stable patients with pulmonary embolism (PE) is undefined. In this study, we assessed the prevalence and clinical outcome of normotensive patients with RV dysfunction among a broad spectrum of PE patients.

Method

This retrospective clinical outcome study included cohort of 186 consecutive patients (age: 62 ± 15 years) with documented PE. Acute RV dysfunction was diagnosed in the presence of one or more of the following criteria: a quotient of RV septal-lateral diameter/LV septal-lateral diameter > 0.9 in the 4 chamber view in TTE or CT, RV hypokinesis (TAPSE < 15 mm), Doppler evidence of pulmonary hypertension (PASP > 40 mmHg) and/or paradox septal systolic motion.

Results

Eighty-eight patients were judged to have RV dysfunction (47.3%). There was no difference in age, gender, prevalence of deep venous thrombosis (DVT), cancer or other risk factors in these two groups. In hospital mortality (21.6% vs. 5.4%; P = 0.001), cardiogenic shock (P = 0.001), and thrombolytic therapy use (P = 0.004) were significantly higher for RV dysfunction patients than for the other group. The multivariate logistic regression models revealed significant associations between RV dysfunction and in-hospital mortality (OR: 3.815, 95% CI: 1.012–10.47, P = 0.001)

Conclusion

A significant proportion (47%) of normotensive patients with acute PE presents with RV dysfunction; these patients with latent hemodynamic impairment have more PE-related shock and in-hospital mortality and may require aggressive therapeutic strategies.