Right Ventricular Outflow Doppler Predicts Low Cardiac Index in Intermediate Risk Pulmonary Embolism

Intermediate-risk pulmonary embolism (PE) has variable outcomes. Current risk stratification models lack the positive predictive value to identify patients at highest risk of PE-related mortality. We identified intermediate-risk PE patients who underwent catheter-based interventions and right heart...

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Vydáno v:Clinical and applied thrombosis/hemostasis Ročník 25; s. 1076029619886062
Hlavní autoři: Brailovsky, Yevgeniy, Lakhter, Vladimir, Weinberg, Ido, Porcaro, Katerina, Haines, Jeremiah, Morris, Stephen, Masic, Dalila, Mancl, Erin, Bashir, Riyaz, Alkhouli, Mohamad, Rosenfield, Kenneth, Mathew, Verghese, Lopez, John, Bechara, Carlos F., Joyce, Cara, Fareed, Jawed, Darki, Amir
Médium: Journal Article
Jazyk:angličtina
Vydáno: Los Angeles, CA SAGE Publications 2019
SAGE PUBLICATIONS, INC
SAGE Publishing
Témata:
Acute Disease
Catheters
Cohort Studies
Echocardiography, Doppler - methods
Embolisms
Female
Heart Ventricles - physiopathology
Humans
Male
Middle Aged
Mortality
Original
Pulmonary arteries
Pulmonary Embolism - diagnostic imaging
Pulmonary embolisms
Regression analysis
Retrospective Studies
Risk Factors
thrombolysis
cardiac index
cardiogenic shock
pulmonary embolism
ISSN:1076-0296, 1938-2723, 1938-2723
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Shrnutí:Intermediate-risk pulmonary embolism (PE) has variable outcomes. Current risk stratification models lack the positive predictive value to identify patients at highest risk of PE-related mortality. We identified intermediate-risk PE patients who underwent catheter-based interventions and right heart catheterization (RHC) and identified those with low cardiac index (CI < 2.2 L/min/m2). We utilized regression models to identify echocardiographic predictors of low CI and Kaplan Meier curve to evaluate PE-related mortality when stratified by the echocardiographic predictor. Of 174 intermediate-risk PE patients, 41 underwent RHC. Within this cohort, 46.3% had low CI. Univariable linear regression identified right ventricular outflow tract velocity time integral (RVOT VTI), right/left ventricular ratio, S prime, inferior vena cava diameter, and pulmonary artery systolic pressure as potential predictors of low CI. Multivariable linear regression identified RVOT VTI as significant predictor of low CI (β coefficient 0.124, 95% confidence interval [CI]: 0.01-0.24, P = .034). Right ventricular outflow tract velocity time integral <9.5 cm was associated with increased PE-related mortality, P = .002. A substantial proportion of intermediate-risk PE patients referred for catheter-based interventions had low CI despite normotension. Right ventricular outflow tract velocity time integral was a significant predictor of low CI. Low RVOT VTI was associated with increased PE-related mortality.
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ISSN:1076-0296
1938-2723
1938-2723
DOI:10.1177/1076029619886062