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...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2019-11-01
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| Series: | Clinical and Applied Thrombosis/Hemostasis |
| Online Access: | https://doi.org/10.1177/1076029619886062 |
| _version_ | 1819213028254547968 |
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| author | Yevgeniy Brailovsky DO, MSc Vladimir Lakhter DO Ido Weinberg MD Katerina Porcaro MD Jeremiah Haines DO Stephen Morris MD Dalila Masic PharmD Erin Mancl PharmD Riyaz Bashir MD Mohamad Alkhouli MD Kenneth Rosenfield MD Verghese Mathew MD John Lopez MD Carlos F. Bechara MD Cara Joyce PhD Jawed Fareed PhD Amir Darki MD, MSc |
| author_facet | Yevgeniy Brailovsky DO, MSc Vladimir Lakhter DO Ido Weinberg MD Katerina Porcaro MD Jeremiah Haines DO Stephen Morris MD Dalila Masic PharmD Erin Mancl PharmD Riyaz Bashir MD Mohamad Alkhouli MD Kenneth Rosenfield MD Verghese Mathew MD John Lopez MD Carlos F. Bechara MD Cara Joyce PhD Jawed Fareed PhD Amir Darki MD, MSc |
| author_sort | Yevgeniy Brailovsky DO, MSc |
| collection | DOAJ |
| description | 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/m 2 ). 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. |
| first_indexed | 2024-12-23T06:52:21Z |
| format | Article |
| id | doaj.art-08de2974ae344011a92efc90a9d2839f |
| institution | Directory Open Access Journal |
| issn | 1938-2723 |
| language | English |
| last_indexed | 2024-12-23T06:52:21Z |
| publishDate | 2019-11-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Clinical and Applied Thrombosis/Hemostasis |
| spelling | doaj.art-08de2974ae344011a92efc90a9d2839f2022-12-21T17:56:23ZengSAGE PublishingClinical and Applied Thrombosis/Hemostasis1938-27232019-11-012510.1177/1076029619886062Right Ventricular Outflow Doppler Predicts Low Cardiac Index in Intermediate Risk Pulmonary EmbolismYevgeniy Brailovsky DO, MSc0Vladimir Lakhter DO1Ido Weinberg MD2Katerina Porcaro MD3Jeremiah Haines DO4Stephen Morris MD5Dalila Masic PharmD6Erin Mancl PharmD7Riyaz Bashir MD8Mohamad Alkhouli MD9Kenneth Rosenfield MD10Verghese Mathew MD11John Lopez MD12Carlos F. Bechara MD13Cara Joyce PhD14Jawed Fareed PhD15Amir Darki MD, MSc16 Division of Cardiology, Loyola University Chicago Stritch School of Medicine, Chicago, IL, USA Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Division of Cardiology, Loyola University Chicago Stritch School of Medicine, Chicago, IL, USA Department of Medicine, Loyola University Chicago Stritch School of Medicine, Chicago, IL, USA Department of Medicine, Loyola University Chicago Stritch School of Medicine, Chicago, IL, USA Division of Pharmacology, Loyola University Chicago Stritch School of Medicine, Chicago, IL, USA Division of Pharmacology, Loyola University Chicago Stritch School of Medicine, Chicago, IL, USA Division of Cardiology, Temple University Hospital, Lewis Katz School of Medicine, Philadelphia, PA, USA Divison of Cardiology, West Virginia University Heart and Vascular Institute, West Virginia University School of Medicine, Morgantown, WV, USA Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Division of Cardiology, Loyola University Chicago Stritch School of Medicine, Chicago, IL, USA Division of Cardiology, Loyola University Chicago Stritch School of Medicine, Chicago, IL, USA Division of Vascular surgery, Loyola University Chicago Stritch School of Medicine, Chicago, IL, USA Department of Public Health Sciences, Loyola University Chicago, Stritch School of Medicine, Loyola University Chicago Stritch School of Medicine, Chicago, IL, USA Department of Pathology, Loyola University Chicago Stritch School of Medicine, Chicago, IL, USA Division of Cardiology, Loyola University Chicago Stritch School of Medicine, Chicago, IL, USAIntermediate-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/m 2 ). 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.https://doi.org/10.1177/1076029619886062 |
| spellingShingle | Yevgeniy Brailovsky DO, MSc Vladimir Lakhter DO Ido Weinberg MD Katerina Porcaro MD Jeremiah Haines DO Stephen Morris MD Dalila Masic PharmD Erin Mancl PharmD Riyaz Bashir MD Mohamad Alkhouli MD Kenneth Rosenfield MD Verghese Mathew MD John Lopez MD Carlos F. Bechara MD Cara Joyce PhD Jawed Fareed PhD Amir Darki MD, MSc Right Ventricular Outflow Doppler Predicts Low Cardiac Index in Intermediate Risk Pulmonary Embolism Clinical and Applied Thrombosis/Hemostasis |
| title | Right Ventricular Outflow Doppler Predicts Low Cardiac Index in Intermediate Risk Pulmonary Embolism |
| title_full | Right Ventricular Outflow Doppler Predicts Low Cardiac Index in Intermediate Risk Pulmonary Embolism |
| title_fullStr | Right Ventricular Outflow Doppler Predicts Low Cardiac Index in Intermediate Risk Pulmonary Embolism |
| title_full_unstemmed | Right Ventricular Outflow Doppler Predicts Low Cardiac Index in Intermediate Risk Pulmonary Embolism |
| title_short | Right Ventricular Outflow Doppler Predicts Low Cardiac Index in Intermediate Risk Pulmonary Embolism |
| title_sort | right ventricular outflow doppler predicts low cardiac index in intermediate risk pulmonary embolism |
| url | https://doi.org/10.1177/1076029619886062 |
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