• Isr Med Assoc J · Nov 2020

    Observational Study

    Re-Appraisal of Echocardiographic Assessment in Patients with Pulmonary Embolism: Prospective Blinded Long-Term Follow-Up.

    • Hezzy Shmueli, Arie Steinvil, Galit Aviram, Sileman Moaad, Adam Sharon, Achiude Bendet, Simon Biner, Yacov Shacham, Jack Sherez, Ricki Megidish, Yifat Hasin, Ester Elazar, Sevan Letourneau-Shesaf, Gad Keren, Shlomo Berliner, and Yan Topilsky.
    • Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
    • Isr Med Assoc J. 2020 Nov 1; 11 (22): 688-695.

    BackgroundAcute pulmonary embolism (PE) is considered to be one of the most common cardiovascular diseases with considerable mortality. Conflicting data imply possible role for echocardiography in assessing this disease.ObjectivesTo determine which of the echo parameters best predicts short-term and long-term mortality in patients with PE.MethodsWe prospectively enrolled 235 patients who underwent computed tomography of pulmonary arteries (CTPA) and transthoracic Echocardiography (TTE) within < 24 hours. TTE included a prospectively designed detailed evaluation of the right heart including right ventricular (RV) myocardial performance index (RIMP), RV end diastolic and end systolic area, RV fractional area change, acceleration time (AT) of pulmonary flow and visual estimation. Interpretation and performance of TTE were blinded to the CTPA results.ResultsAlthough multiple TTE parameters were associated with PE, all had low discriminative capacity (AUC < 0.7). Parameters associated with 30-day mortality in univariate analysis were acceleration time (AT) < 81 msec (P = 0.04), stroke volume < 44 cc (P = 0.005), and RIMP > 0.42 (P = 0.05). The only RV independent echo parameter associated with poor long-term prognosis (adjusted for significant clinical, and routine echo associates of mortality) was RIMP (hazard ratio 3.0, P = 0.04). The only independent RV echo parameters associated with mortality in PE patients were RIMP (P = 0.05) and AT (P = 0.05). Addition of RIMP to nested models eliminated the significance of all other parameters assessing RV function.ConclusionsDoppler-based parameters like pulmonary flow AT, RIMP, and stroke volume, have additive value in addition to visual RV estimation to assess prognosis in patients with PE.

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