Echocardiography helps predict PE outcomes

Transthoracic echocardiography can help clinicians predict short-term mortality outcomes for patients with acute pulmonary embolism (PE), according to a study published online August 26 in the Journal of the American Heart Association.

The findings could lead to better care strategies for patients at risk of cardiovascular disease, wrote a team led by Dr. Behnood Bikdeli of Columbia University Medical Center/NewYork-Presbyterian Hospital in New York City.

"Acute pulmonary embolism is a serious thromboembolic condition accounting for thousands of hospitalizations and associated with high short-term mortality rates," the group wrote. "Some studies suggest that transthoracic echocardiography could help in the early risk stratification of patients with acute PE."

Although transthoracic echocardiography is often used to assess patients with acute PE within 72 hours of diagnosis -- and its utilization has increased in recent years -- it has been unclear exactly how effective it is, according to Bikdeli and colleagues.

"[Research] results have been inconsistent and the use of transthoracic echocardiography in real life and its prognostic value have not been consistently studied," they wrote.

To remedy this, the researchers used data from RIETE (Registro Informatizado Enfermedad TromboEmbolica), a registry coordinated by Spanish researchers that includes 35,395 patients who experienced acute pulmonary embolism between 2001 and 2017. They evaluated the association between three variables (right atrial enlargement, right ventricular hypokinesis, and right heart thrombi) and 30-day PE-related mortality. The group adjusted data for demographics, PE severity, and other comorbidities.

Among the study cohort, 42.8% of patients underwent transthoracic echocardiography. Overall, younger, female patients with a history of heart disease, heart failure, atrial fibrillation, tachycardia, and hypotension had a higher incidence of transthoracic echocardiography use. Of the study participants, 5.3% died within the first 30 days after presenting with PE; of these, 29.7% died of PE.

Findings on transthoracic echo that predict PE mortality
Finding	Odds ratio for 30-day PE-related mortality
Right heart thrombi	8.51
Right atrial enlargement	6.69
Right ventricular hypokinesis	5.59

p < 0.001 for all

"In our study ... early transthoracic echocardiography was performed in over one-third of patients, and the proportion increased over time," the group wrote. "History of prior cardiovascular disease ... and clinical markers of PE severity were among the main predictors of early transthoracic echocardiography."

Bikdeli and colleagues hope their findings will prompt further research.

"Future studies should identify the optimal management strategies for high-risk subgroups identified by early echocardiography," they concluded.