Echocardiography does not predict mortality in hemodynamically stable elderly patients with acute pulmonary embolism
type: Article
item type: journalArticle
is part of: Thromb Res
authors: Person
  surname: Hofmann
  given name: E.
authors: Person
  surname: Limacher
  given name: A.
authors: Person
  surname: Mean
  given name: M.
authors: Person
  surname: Kucher
  given name: N.
authors: Person
  surname: Righini
  given name: M.
authors: Person
  surname: Frauchiger
  given name: B.
authors: Person
  surname: Beer
  given name: J. H.
authors: Person
  surname: Osterwalder
  given name: J.
authors: Person
  surname: Aschwanden
  given name: M.
authors: Person
  surname: Matter
  given name: C. M.
authors: Person
  surname: Banyai
  given name: M.
authors: Person
  surname: Egloff
  given name: M.
authors: Person
  surname: Hugli
  given name: O.
authors: Person
  surname: Staub
  given name: D.
authors: Person
  surname: Bounameaux
  given name: H.
authors: Person
  surname: Rodondi
  given name: N.
authors: Person
  surname: Aujesky
  given name: D.
subject: Aged
subject: Aged, 80 and over
subject: Cohort Studies
subject: Echocardiography
subject: Echocardiography/*methods
subject: Female
subject: Humans
subject: Male
subject: Mortality
subject: Prospective Studies
subject: Pulmonary Embolism/*diagnostic imaging/mortality
subject: Pulmonary embolism
subject: Treatment Outcome
abstract: BACKGROUND: The evidence on the prognostic value of transthoracic echocardiography (TTE) in elderly, hemodynamically stable patients with Pulmonary Embolism (PE) is limited. OBJECTIVES: To evaluate the prevalence of common echocardiographic signs of right ventricular (RV) dysfunction and their prognostic impact in hemodynamically stable patients aged >/=65years with acute PE in a prospective multicenter cohort. METHODS: TTE was performed by cardiologists. We defined RV dysfunction as a RV/left ventricular ratio >0.9 or RV hypokinesis (primary definition) or the presence of >/=1 or >/=2 of 6 predefined echocardiographic signs (secondary definitions). Outcomes were overall mortality and mortality/non-fatal recurrent venous thromboembolism (VTE) at 30days, adjusting for the Pulmonary Embolism Severity Index risk score and highly sensitive troponin T values. RESULTS: Of 400 patients, 36% had RV dysfunction based on our primary definition, and 81% (>/=1 sign) and 53% (>/=2 signs) based on our secondary definitions, respectively. Using our primary definition, there was no association between RV dysfunction and mortality (adjusted HR 0.90, 95% CI 0.31-2.58) and mortality/non-fatal VTE (adjusted HR 1.09, 95% CI 0.40-2.98). Similarly, there was no statistically significant association between the presence of >/=1 or >/=2 echocardiographic signs (secondary definitions) and clinical outcomes. CONCLUSION: The prevalence of echocardiographic RV dysfunction varied widely depending upon the definition used. There was no association between RV dysfunction and clinical outcomes. Thus, TTE may not be suitable as a stand-alone risk assessment tool in elderly patients with acute PE. CLINICAL TRIAL REGISTRATION: http://clinicaltrials.gov. Identifier: NCT00973596.
date: 2016-08-09
pages: 67-71
coverage: 27498122

Thromb Res
type: Journal
volume: 145
identifier: DOI 10.1016/j.thromres.2016.07.014
identifier: ISSN 1879-2472 (Electronic) 0049-3848 (Linking)