Assessment of right ventricular function in acute pulmonary embolism

Background The optimal approach to assess right ventricular ( RV ) function in patients with acute symptomatic pulmonary embolism ( PE ) lacks clarity. Methods This study aimed to evaluate the optimal approach to assess RV function in normotensive patients with acute symptomatic PE. Outcomes assessed through 30-days after the diagnosis of PE included all-cause mortality and complicated course. Results Eight hundred and forty eight patients were enrolled. Computed tomography ( MDCT ) and echocardiography ( TTE ) agreed on the presence or absence of RV overload in 449 (53%) patients. The combination of the simplified Pulmonary Embolism Severity Index ( sPESI ) and MDCT showed a negative predictive value for 30-day all-cause mortality of 100%. Of the 43% that had a sPESI of >0 points and MDCT RV enlargement, 41 (11.3%) experienced a complicated course that included 24 (6.6%) deaths. One hundred and twenty nine patients (15%) had a sPESI of >0 points, MDCT and echocardiographic RV overload. Of these, 21 (16.3%) experienced a complicated course within the first 30 days, and 10 (7.7%) of them died. Conclusions Incorporation of echocardiographic RV overload to the sPESI and MDCT did not improve identification of low-risk PE patients, while it improved identification of those at intermediate-high risk for short-term complications.