Right Ventricular Echocardiographic Parameters Are Associated with Mortality after Acute Pulmonary Embolism

Background There is limited information on the utility of certain echocardiographic measurements, such as right ventricular (RV) strain analysis, in predicting mortality in patients with acute pulmonary embolism (PE). Methods A total of 211 patients with acute PE admitted to a medical intensive care unit (ICU) were retrospectively identified. Echocardiographic variables were prospectively measured in this cohort. The focus was on ICU, hospital, and long-term mortality. Results The mean age was 61 ± 15 years. Median Acute Physiology and Chronic Health Evaluation IV and simplified Pulmonary Embolism Severity Index scores were 60 (interquartile range, 40–71) and 2 (interquartile range, 1–2), respectively. Thirty-eight patients (18%) died during the sentinel hospitalization (13% died in the ICU). A total of 61 patients (28.9%) died during a median follow-up period of 15 months (interquartile range, 5–26 months). The echocardiographic variables associated with long-term mortality (from PE diagnosis) were ratio of RV to left ventricular end-diastolic diameter (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.2–4.8), tricuspid annular plane systolic excursion (HR, 0.53; 95% CI, 0.31–0.92), and RV–right atrial gradient (HR, 1.02; 95% CI, 1.01–1.4). ICU mortality was associated with ratio of RV to LV end-diastolic diameter (HR, 4.4; 95% CI, 1.3–15), RV systolic pressure (HR, 1.03; 95% CI, 1.01–1.05), tricuspid annular plane systolic excursion (HR, 0.4; 95% CI, 0.18–0.9), and inferior vena cava collapsibility