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Echocardiography does not predict mortality in hemodynamically stable elderly patients with acute pulmonary embolism

Eveline Hofmann, Andreas Limacher, Marie Méan, Nils Kucher, Marc Righini, Beat Frauchiger, Jürg-Hans Beer, Joseph Osterwalder, Markus Aschwanden, Christian M Matter, Martin Banyai, Michael Egloff, Olivier Hugli, Daniel Staub, Henri Bounameaux, Nicolas Rodondi & Drahomir Aujesky

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.
   
citation Hofmann E, Limacher A, Méan M, Kucher N, Righini M, Frauchiger B, Beer J H, Osterwalder J, Aschwanden M, Matter C M, Banyai M, Egloff M, Hugli O, Staub D, Bounameaux H, Rodondi N, Aujesky D. Echocardiography does not predict mortality in hemodynamically stable elderly patients with acute pulmonary embolism. Thromb Res 2016; 145:67-71.
   
type journal paper/review (English)
date of publishing 27-07-2016
journal title Thromb Res (145)
ISSN electronic 1879-2472
pages 67-71
PubMed 27498122
DOI 10.1016/j.thromres.2016.07.014