Prognostic echocardiographic parameters in hospitalized patients with pulmonary embolism

Authors

  • Galina SORICI N. Testemitanu State University of Medicine and pharmacy
  • Nadejda DIACONU Institute of Cardiology
  • Irina KIVIRIJIK N. Testemitanu State University of Medicine and pharmacy
  • Tatiana CUZOR Institute of Cardiology
  • Aurel GROSU Institute of Cardiology

DOI:

https://doi.org/10.52692/1857-0011.2024.1-78.09

Keywords:

Acute pulmonary embolism, echocardiography, right ventricular dysfunction, prognosis

Abstract

Pulmonary embolism (PE) is considered one of the most common cardiovascular diseases with considerable mortality. Echocardiography remains an important investigation in the evaluation of these patients, with some echocardiographic parameters playing an incremental role in prognostic evaluation.Objectives: To determine the spectrum of echocardiographic changes in patients hospitalized with pulmonary embolism at the Institute of Cardiology of the Republic of Moldova and to highlight parameters with significant prognostic value in relation to risk scores for mortality stratification in PE. Materials and methods: We prospectively enrolled 168 patients admitted to the Institute of Cardiology. All patients were evaluated by transthoracic echocardiography. Results: Parameters most associated with in-hospital mortality at 30 days were: right atrial area (RA) >18cm2 (p=0.007), tricuspid valve regurgitation (TR) grade (p=0.002), tissue systolic velocity of the anterior wall of the right ventricle (RV) (p=0.03), inferior vena cava diameter (p=0.04), RV/LV ratio >1.0 (p=0.04), and TAPSE/PSAP index <0.4 (p<0.008). Conclusions: Echocardiographic parameters such as tricuspid valve regurgitation grade, RA area, tissue systolic velocity of the anterior RV wall, TAPSE/PSAP index, and interventricular ratio have additive value in evaluating prognosis in patients with PE.

References

Giordano NJ, Jansson PS, Young MN, Hagan KA, Kabrhel C. Epidemiology, Pathophysiology, Stratification, and Natural History of Pulmonary Embolism. Tech Vasc Interv Radiol [Internet]. 2017 Sep 1 [cited 2024 Mar 8];20(3):135–40. Available from: https://pubmed.ncbi.nlm.nih.gov/29029707/

Freund Y, Chauvin A, Jimenez S, Philippon AL, Curac S, Fémy F, et al. Effect of a Diagnostic Strategy Using an Elevated and Age-Adjusted D-Dimer Threshold on Thromboembolic Events in Emergency Department Patients With Suspected Pulmonary Embolism: A Randomized Clinical Trial. JAMA [Internet]. 2021 Dec 7 [cited 2024 Mar 8];326(21):2141–9. Available from: https://pubmed.ncbi.nlm.nih.gov/34874418/

Konstantinides S V., Meyer G, Bueno H, Galié N, Gibbs JSR, Ageno W, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS). Eur Heart J. 2020 Jan 21;41(4):543–603.

Moore AJE, Wachsmann J, Chamarthy MR, Panjikaran L, Tanabe Y, Rajiah P. Imaging of acute pulmonary embolism: an update. Cardiovasc Diagn Ther [Internet]. 2018 Jun 1 [cited 2024 Mar 8];8(3):225–43. Available from: https://pubmed.ncbi.nlm.nih.gov/30057872/

Leidi A, Bex S, Righini M, Berner A, Grosgurin O, Marti C. Risk Stratification in Patients with Acute Pulmonary Embolism: Current Evidence and Perspectives. J Clin Med [Internet]. 2022 May 1 [cited 2024 Mar 8];11(9). Available from: https://pubmed.ncbi.nlm.nih.gov/35566658/

Moor J, Baumgartner C, Meán M, Stalder O, Limacher A, Rodondi N, et al. Validation of the 2019 European Society of Cardiology Risk Stratification Algorithm for Pulmonary Embolism in Normotensive Elderly Patients. Thromb Haemost [Internet]. 2021 Dec 1 [cited 2024 Mar 8];121(12):1660–7. Available from: https://pubmed.ncbi.nlm.nih.gov/33823559/

Konstantinides S V., Meyer G, Bueno H, Galié N, Gibbs JSR, Ageno W, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS). Vol. 41, European Heart Journal. 2020.

Aujesky D, Obrosky DS, Stone RA, Auble TE, Perrier A, Cornuz J, et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med [Internet]. 2005 Oct 15 [cited 2024 Mar 8];172(8):1041–6. Available from: https://pubmed.ncbi.nlm.nih.gov/16020800/

Lee K, Kwon O, Lee EJ, Sin MJ, Lee JS, Lee S, et al. Prognostic value of echocardiographic parameters for right ventricular function in patients with acute non- massive pulmonary embolism. Heart Vessels. 2019 Jul 12;34(7):1187–95.

Kurnicka K, Lichodziejewska B, Goliszek S, Dzikowska-Diduch O, Zdończyk O, Kozłowska M, et al. Echocardiographic Pattern of Acute Pulmonary Embolism: Analysis of 511 Consecutive Patients. J Am Soc Echocardiogr [Internet]. 2016 Sep 1 [cited 2024 Mar 10];29(9):907–13. Available from: https://pubmed.ncbi.nlm.nih.gov/27427291/

Kurnicka K, Lichodziejewska B, Ciurzyński M, Kostrubiec M, Goliszek S, Zdończyk O, et al. 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. 2020;27(5):558–65.

Guazzi M, Bandera F, Pelissero G, Castelvecchio S, Menicanti L, Ghio S, et al. Tricuspid annular plane systolic excursion and pulmonary arterial systolic pressure relationship in heart failure: An index of right ventricular contractile function and prognosis. Am J Physiol - Hear Circ Physiol [Internet]. 2013 Nov 1 [cited 2024 Mar 10];305(9):1373–81. Available from: https://journals.physiology.org/doi/10.1152/ajpheart.00157.2013

Cho SU, Cho YD, Choi SH, Yoon YH, Park JH, Park SJ, et al. Assessing the severity of pulmonary embolism among patients in the emergency department: Utility of RV/LV diameter ratio. PLoS One [Internet]. 2020 Nov 1 [cited 2024 Mar 8];15(11). Available from: https://pubmed.ncbi.nlm.nih.gov/33211719/.

Published

2024-08-05

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Research Article

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