Toosi et al identified echocardiographic findings that are associated with prognosis for a patient with an acute pulmonary embolism (PE). The authors are from Saint Joseph Hospital (Chicago) and Emory University.
Patient selection: acute pulmonary embolism
Outcome: in-hospital mortality
stroke index =
= (heart rate in beats per minute) / (systolic blood pressure in mm Hg)
Features of right ventricular dysfunction with prognostic significance in acute PE:
(1) moderate or severe right ventricular hypokinesis
(2) ratio of RV to LV end-diastolic diameter > 1
(3) systolic pulmonary artery pressure (PAP) > 50 mm Hg
|
Stroke Index
|
RV Hypokinesis
|
Mortality
|
|
< 1
|
not moderate or severe
|
0%
|
|
< 1
|
moderate or severe
|
13%
|
|
>= 1
|
not moderate or severe
|
0%
|
|
>= 1
|
moderate or severe
|
39%
|
The negative predictive value for moderate or severe right ventricular hypokinesis was 100%.
Additional findings associated with in-hospital mortality:
(1) E/A ratio at mitral valve < 1
(2) right ventricular end-diastolic diameter > 3 cm
(3) interventricular septal flattening
(4) peak TR velocity > 2.8 m/s
