1
|
Left Ventricle Outflow Tract Velocity-Time Index and Right Ventricle to Left Ventricle Ratio as Predictors for in Hospital Outcome in Intermediate-Risk Pulmonary Embolism. Diagnostics (Basel) 2022; 12:diagnostics12051226. [PMID: 35626382 PMCID: PMC9139934 DOI: 10.3390/diagnostics12051226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 12/10/2022] Open
Abstract
Accurate estimation of risk with both imaging and biochemical parameters in intermediate risk pulmonary embolism (PE) remains challenging. The aim of the study was to evaluate echocardiographic parameters that reflect right and left heart hemodynamic as predictors of adverse events in intermediate risk PE. This was a retrospective observational study on patients with computed tomography pulmonary angiography diagnosis of PE admitted at Cardiology department of the Clinical Emergency Hospital of Oradea, Romania between January 2018—December 2021. Echocardiographic parameters obtained at admission were studied as predictors of in hospital adverse events. The following adverse outcomes were registered: death, resuscitated cardiac arrest, hemodynamic deterioration and need of rescue thrombolysis. An adverse outcome was present in 50 patients (12.62%). PE related death was registered in 17 patients (4.3%), resuscitated cardiac arrest occurred in 6 patients (1.51%). Another 20 patients (5.05%) required escalation of therapy with thrombolysis and 7 (1.76%) patients developed haemodynamic instability. Echocardiographic independent predictors for in hospital adverse outcome were RV/LV ≥ 1 (HR = 3.599, 95% CI 1.378−9.400, p = 0.009) and VTI ≤ 15 mm (HR = 11.711, 95% CI 4.336−31.633, p < 0.001). The receiver operator curve renders an area under curve for LVOT VTI ≤ 15 mm of 0.792 (95% CI 0.719−0.864, p < 0.001) and for a RV/LV ≥ 1 of 0.746 (95% CI 0.671−0.821, p < 0.001). A combined criterion (LVOT VTI ≤ 15 and RV/LV ≥ 1) showed a positive predictive value of 75% and a negative predictive value of 95% regarding in hospital adverse outcomes. Low LVOT VTI and increased RV/LV are useful for identifying normotensive patients with PE at risk for short term adverse outcomes. Combining an LVOT VTI ≤ 15 cm with a RV/LV ≥ 1 can identify with increased accuracy PE patients with impending risk of clinical deterioration.
Collapse
|
2
|
Kurnicka K, Lichodziejewska B, Ciurzyński M, Kostrubiec M, Goliszek S, Zdończyk O, Dzikowska-Diduch O, Palczewski P, Skowrońska M, Koć M, Grudzka K, Pruszczyk P. Peak systolic velocity of tricuspid annulus is inferior to tricuspid annular plane systolic excursion for 30 days prediction of adverse outcome in acute pulmonary embolism. Cardiol J 2018; 27:558-565. [PMID: 30484266 DOI: 10.5603/cj.a2018.0145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 11/01/2018] [Accepted: 11/08/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Tricuspid annular plane systolic excursion (TAPSE) is an established index of right ventricular (RV) systolic function and a significant predictor in normotensive patients with pulmonary embolism (PE). Recently, Doppler tissue imaging-derived tricuspid annular systolic velocity (TV S'), a modern parameter of RV function was reported to be useful in the diagnosis and prognosis of a broad spectrum of heart diseases. Therefore, herein, is an analysis of the prognostic value of both parameters in normotensive PE patients. METHODS One hundred and thirty nine consecutive PE patients (76 female, age 56.4 ± 19.5 years) were included in this study. All patients were initially anticoagulated. Transthoracic echocardiography was performed on admission. The study endpoint (SE) was defined as PE-related 30-day mortality and/or need for rescue thrombolysis. RESULTS Seven (5%) patients who met the criteria for SE presented more severe RV dysfunction at echocardiography. Univariable Cox regression analysis showed that RV/LV ratio predicted SE with hazard risk (HR) 10.6 (1.4-80.0; p = 0.02); TAPSE and TV S' showed HR 0.77 (0.67-0.89), p < 0.001, and 0.71 (0.52-0.97), p = 0.03, respectively. Area under the curve for TAPSE in the prediction of SE was 0.881; 95% CI 0.812-0.932, p = 0.0001, for TV S' was 0.751; 95% CI 0.670-0.820, p = 0.001. Multivariable analysis showed that the optimal prediction model included TAPSE and systolic blood pressure (SBP showed HR 0.89 95% CI 0.83-0.95, p < 0.001 and TAPSE HR 0.67, 95% CI 0.52-0.87, p<0.03). Kaplan-Meier analysis showed that initially PE patients with TAPSE ≥ 18 mm had a much more favorable prognosis that patients with TAPSE < 18 mm (p < 0.01), while analysis of S' was only of borderline statistical significance. CONCLUSIONS It seems that TV S' is inferior to TAPSE for 30 day prediction of adverse outcome in acute pulmonary embolism.
Collapse
Affiliation(s)
- Katarzyna Kurnicka
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland.
| | - Barbara Lichodziejewska
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland
| | - Michał Ciurzyński
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland
| | - Maciej Kostrubiec
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland
| | - Sylwia Goliszek
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland
| | - Olga Zdończyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland
| | - Olga Dzikowska-Diduch
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland
| | - Piotr Palczewski
- 1 st Department of Radiology, Medical University of Warsaw, Chałubińskiego str 5, 02-004 Warsaw, Poland
| | - Marta Skowrońska
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland
| | - Marcin Koć
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland
| | - Katarzyna Grudzka
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland
| |
Collapse
|
3
|
Dahhan T, Siddiqui I, Tapson VF, Velazquez EJ, Sun S, Davenport CA, Samad Z, Rajagopal S. Clinical and echocardiographic predictors of mortality in acute pulmonary embolism. Cardiovasc Ultrasound 2016; 14:44. [PMID: 27793158 PMCID: PMC5086059 DOI: 10.1186/s12947-016-0087-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/19/2016] [Indexed: 01/11/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate the utility of adding quantitative assessments of cardiac function from echocardiography to clinical factors in predicting the outcome of patients with acute pulmonary embolism (PE). METHODS Patients with a diagnosis of acute PE, based on a positive ventilation perfusion scan or computed tomography (CT) chest angiogram, were identified using the Duke University Hospital Database. Of these, 69 had echocardiograms within 24-48 h of the diagnosis that were suitable for offline analysis. Clinical features that were analyzed included age, gender, body mass index, vital signs and comorbidities. Echocardiographic parameters that were analyzed included left ventricular (LV) ejection fraction (EF), regional, free wall and global RV speckle-tracking strain, RV fraction area change (RVFAC), Tricuspid Annular Plane Systolic Excursion (TAPSE), pulmonary artery acceleration time (PAAT) and RV myocardial performance (Tei) index. Univariable and multivariable regression statistical analysis models were used. RESULTS Out of 69 patients with acute PE, the median age was 55 and 48 % were female. The median body mass index (BMI) was 27 kg/m2. Twenty-nine percent of the cohort had a history of cancer, with a significant increase in cancer prevalence in non-survivors (57 % vs 29 %, p = 0.02). Clinical parameters including heart rate, respiratory rate, troponin T level, active malignancy, hypertension and COPD were higher among non-survivors when compared to survivors (p ≤ 0.05). Using univariable analysis, NYHA class III symptoms, hypoxemia on presentation, tachycardia, tachypnea, elevation in Troponin T, absence of hypertension, active malignancy and chronic obstructive pulmonary disease (COPD) were increased in non-survivors compared to survivors (p ≤ 0.05). In multivariable models, RV Tei Index, global and free (lateral) wall RVLS were found to be negatively associated with survival probability after adjusting for age, gender and systolic blood pressure (p ≤ 0.05). CONCLUSION The addition of echocardiographic assessment of RV function to clinical parameters improved the prediction of outcomes for patients with acute PE. Larger studies are needed to validate these findings.
Collapse
Affiliation(s)
- Talal Dahhan
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University, Durham, NC, USA.,Center for Pulmonary Vascular Disease, Box 102351, DUMC, Durham, NC, 27710, USA
| | - Irfan Siddiqui
- Department of Medicine, East Carolina University, Greenville, NC, USA
| | - Victor F Tapson
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Eric J Velazquez
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC, USA
| | - Stephanie Sun
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Clemontina A Davenport
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Zainab Samad
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC, USA
| | - Sudarshan Rajagopal
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC, USA. .,Center for Pulmonary Vascular Disease, Box 102351, DUMC, Durham, NC, 27710, USA.
| |
Collapse
|