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Falsetti L, Marra AM, Zaccone V, Sampaolesi M, Riccomi F, Giovenali L, Guerrieri E, Viticchi G, D'Agostino A, Gentili T, Nitti C, Moroncini G, Cittadini A, Salvi A. Echocardiographic predictors of mortality in intermediate-risk pulmonary embolism. Intern Emerg Med 2022; 17:1287-1299. [PMID: 35059990 DOI: 10.1007/s11739-021-02910-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/09/2021] [Indexed: 12/13/2022]
Abstract
Data regarding further risk stratification of intermediate-risk pulmonary embolism (IR-PE) are scanty. Whether transthoracic echocardiography may be helpful in further risk assessment of death in such population has still to be proven. Two-hundred fifty-four consecutive patients (51.6% females, age 63.7 ± 17.3 years) with IR-PE admitted to a tertiary regional referral center were enrolled. Patients underwent a complete transthoracic echocardiography within 36 h from hospital admission, on top of clinical assessment, physical examination, computer tomography pulmonary angiography (CTPA), and serum measurement of Troponin I (TnI) levels. The occurrence of 90 day mortality was chosen as primary outcome measure. When compared to survivors, non-surviving IR-PE patients had smaller left-ventricular end-diastolic volumes (39.8 ± 20.9 vs 49.4 ± 19.9 ml/m2, p = 0.006) with reduced stroke volume index (SVi) (24.7 ± 10.9 vs 30.9 ± 12.6 ml/m2, p: 0.004) and time-velocity integral at left-ventricular outflow tract (VTILVOT) (0.17 ± 0.03 vs 0.20 ± 0.04 m, p = 0.0001), whereas no differences were recorded regarding right heart parameters. Cox regression analysis revealed that right atrial enlargement (RAE) (HR 3.432, 5-95% CI 1.193-9.876, p: 0.022), the ratio between tricuspid annulus plane excursion and pulmonary arterial systolic pressure (TAPSE/PASp) (HR 4.833, 5-95% 1.230-18.986, p = 0.024), as well as SVi (HR 11.199, 5-95% CI 2.697-48.096, p = 0.001) and VTILVOT (HR 4.212, 5-95% CI 1.384-12.820, p = 0.011) were powerful independent predictors of mortality. Neither CTPA RV/LV nor TnI resulted associated with impaired survival. In intermediate-risk pulmonary embolism, RAE, TAPSE/PASp ratio, SVi, and VTILVOT predict independently prognosis to a greater extent than CTPA and TnI.
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Affiliation(s)
- Lorenzo Falsetti
- Internal and Subintensive Medicine Department, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Via Conca 71, Ancona, Italy.
| | - Alberto Maria Marra
- Department of Translational Medical Sciences, "Federico II" University Hospital and School of Medicine, Naples, Italy
- Center for Pulmonary Hypertension, Thoraxclinic at Heidelberg University Hospital, Heidelberg, Germany
| | - Vincenzo Zaccone
- Internal and Subintensive Medicine Department, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Via Conca 71, Ancona, Italy
| | - Mattia Sampaolesi
- Emergency Medicine Residency Program, Marche Polytechnic University, Ancona, Italy
| | - Francesca Riccomi
- Emergency Medicine Residency Program, Marche Polytechnic University, Ancona, Italy
| | - Laura Giovenali
- Emergency Medicine Residency Program, Marche Polytechnic University, Ancona, Italy
| | - Emanuele Guerrieri
- Emergency Medicine Residency Program, Marche Polytechnic University, Ancona, Italy
| | - Giovanna Viticchi
- Clinica di Neurologia, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Ancona, Italy
| | | | - Tamira Gentili
- Internal and Subintensive Medicine Department, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Via Conca 71, Ancona, Italy
| | - Cinzia Nitti
- Internal and Subintensive Medicine Department, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Via Conca 71, Ancona, Italy
| | - Gianluca Moroncini
- Clinica Medica, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Ancona, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, "Federico II" University Hospital and School of Medicine, Naples, Italy
| | - Aldo Salvi
- Internal and Subintensive Medicine Department, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Via Conca 71, Ancona, Italy
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Falsetti LG, Merelli E, Rucco M, Nitti C, Gentili T, Pennacchioni M, Salvi A. A data-driven clinical prediction rule for pulmonary embolism. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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