Clinical and echocardiographic predictors of mortality in acute pulmonary embolism
Abstract Purpose The aim of this study was to evaluate the utility of adding quantitative assessments of cardiac function from echocardiography to clinical factors in predicting the outcome of patients with acute pulmonary embolism (PE). Methods Patients with a diagnosis of acute PE, based on a posi...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2016-10-01
|
| Series: | Cardiovascular Ultrasound |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12947-016-0087-y |
| _version_ | 1819327025076240384 |
|---|---|
| author | Talal Dahhan Irfan Siddiqui Victor F. Tapson Eric J. Velazquez Stephanie Sun Clemontina A. Davenport Zainab Samad Sudarshan Rajagopal |
| author_facet | Talal Dahhan Irfan Siddiqui Victor F. Tapson Eric J. Velazquez Stephanie Sun Clemontina A. Davenport Zainab Samad Sudarshan Rajagopal |
| author_sort | Talal Dahhan |
| collection | DOAJ |
| description | Abstract Purpose The aim of this study was to evaluate the utility of adding quantitative assessments of cardiac function from echocardiography to clinical factors in predicting the outcome of patients with acute pulmonary embolism (PE). Methods Patients with a diagnosis of acute PE, based on a positive ventilation perfusion scan or computed tomography (CT) chest angiogram, were identified using the Duke University Hospital Database. Of these, 69 had echocardiograms within 24–48 h of the diagnosis that were suitable for offline analysis. Clinical features that were analyzed included age, gender, body mass index, vital signs and comorbidities. Echocardiographic parameters that were analyzed included left ventricular (LV) ejection fraction (EF), regional, free wall and global RV speckle-tracking strain, RV fraction area change (RVFAC), Tricuspid Annular Plane Systolic Excursion (TAPSE), pulmonary artery acceleration time (PAAT) and RV myocardial performance (Tei) index. Univariable and multivariable regression statistical analysis models were used. Results Out of 69 patients with acute PE, the median age was 55 and 48 % were female. The median body mass index (BMI) was 27 kg/m2. Twenty-nine percent of the cohort had a history of cancer, with a significant increase in cancer prevalence in non-survivors (57 % vs 29 %, p = 0.02). Clinical parameters including heart rate, respiratory rate, troponin T level, active malignancy, hypertension and COPD were higher among non-survivors when compared to survivors (p ≤ 0.05). Using univariable analysis, NYHA class III symptoms, hypoxemia on presentation, tachycardia, tachypnea, elevation in Troponin T, absence of hypertension, active malignancy and chronic obstructive pulmonary disease (COPD) were increased in non-survivors compared to survivors (p ≤ 0.05). In multivariable models, RV Tei Index, global and free (lateral) wall RVLS were found to be negatively associated with survival probability after adjusting for age, gender and systolic blood pressure (p ≤ 0.05). Conclusion The addition of echocardiographic assessment of RV function to clinical parameters improved the prediction of outcomes for patients with acute PE. Larger studies are needed to validate these findings. |
| first_indexed | 2024-12-24T13:04:16Z |
| format | Article |
| id | doaj.art-3e2dafddca68468ebd8dfe4d3e1f77ad |
| institution | Directory Open Access Journal |
| issn | 1476-7120 |
| language | English |
| last_indexed | 2024-12-24T13:04:16Z |
| publishDate | 2016-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Ultrasound |
| spelling | doaj.art-3e2dafddca68468ebd8dfe4d3e1f77ad2022-12-21T16:54:03ZengBMCCardiovascular Ultrasound1476-71202016-10-011411910.1186/s12947-016-0087-yClinical and echocardiographic predictors of mortality in acute pulmonary embolismTalal Dahhan0Irfan Siddiqui1Victor F. Tapson2Eric J. Velazquez3Stephanie Sun4Clemontina A. Davenport5Zainab Samad6Sudarshan Rajagopal7Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke UniversityDepartment of Medicine, East Carolina UniversityDepartment of Medicine, Division of Pulmonary and Critical Care Medicine, Cedars Sinai Medical CenterDepartment of Medicine, Division of Cardiology, Duke UniversityDepartment of Biostatistics and Bioinformatics, Duke University Medical CenterDepartment of Biostatistics and Bioinformatics, Duke University Medical CenterDepartment of Medicine, Division of Cardiology, Duke UniversityDepartment of Medicine, Division of Cardiology, Duke UniversityAbstract Purpose The aim of this study was to evaluate the utility of adding quantitative assessments of cardiac function from echocardiography to clinical factors in predicting the outcome of patients with acute pulmonary embolism (PE). Methods Patients with a diagnosis of acute PE, based on a positive ventilation perfusion scan or computed tomography (CT) chest angiogram, were identified using the Duke University Hospital Database. Of these, 69 had echocardiograms within 24–48 h of the diagnosis that were suitable for offline analysis. Clinical features that were analyzed included age, gender, body mass index, vital signs and comorbidities. Echocardiographic parameters that were analyzed included left ventricular (LV) ejection fraction (EF), regional, free wall and global RV speckle-tracking strain, RV fraction area change (RVFAC), Tricuspid Annular Plane Systolic Excursion (TAPSE), pulmonary artery acceleration time (PAAT) and RV myocardial performance (Tei) index. Univariable and multivariable regression statistical analysis models were used. Results Out of 69 patients with acute PE, the median age was 55 and 48 % were female. The median body mass index (BMI) was 27 kg/m2. Twenty-nine percent of the cohort had a history of cancer, with a significant increase in cancer prevalence in non-survivors (57 % vs 29 %, p = 0.02). Clinical parameters including heart rate, respiratory rate, troponin T level, active malignancy, hypertension and COPD were higher among non-survivors when compared to survivors (p ≤ 0.05). Using univariable analysis, NYHA class III symptoms, hypoxemia on presentation, tachycardia, tachypnea, elevation in Troponin T, absence of hypertension, active malignancy and chronic obstructive pulmonary disease (COPD) were increased in non-survivors compared to survivors (p ≤ 0.05). In multivariable models, RV Tei Index, global and free (lateral) wall RVLS were found to be negatively associated with survival probability after adjusting for age, gender and systolic blood pressure (p ≤ 0.05). Conclusion The addition of echocardiographic assessment of RV function to clinical parameters improved the prediction of outcomes for patients with acute PE. Larger studies are needed to validate these findings.http://link.springer.com/article/10.1186/s12947-016-0087-yEchocardiographyPulmonary embolismRight ventricular functionSpeckle-tracking echocardiography |
| spellingShingle | Talal Dahhan Irfan Siddiqui Victor F. Tapson Eric J. Velazquez Stephanie Sun Clemontina A. Davenport Zainab Samad Sudarshan Rajagopal Clinical and echocardiographic predictors of mortality in acute pulmonary embolism Cardiovascular Ultrasound Echocardiography Pulmonary embolism Right ventricular function Speckle-tracking echocardiography |
| title | Clinical and echocardiographic predictors of mortality in acute pulmonary embolism |
| title_full | Clinical and echocardiographic predictors of mortality in acute pulmonary embolism |
| title_fullStr | Clinical and echocardiographic predictors of mortality in acute pulmonary embolism |
| title_full_unstemmed | Clinical and echocardiographic predictors of mortality in acute pulmonary embolism |
| title_short | Clinical and echocardiographic predictors of mortality in acute pulmonary embolism |
| title_sort | clinical and echocardiographic predictors of mortality in acute pulmonary embolism |
| topic | Echocardiography Pulmonary embolism Right ventricular function Speckle-tracking echocardiography |
| url | http://link.springer.com/article/10.1186/s12947-016-0087-y |
| work_keys_str_mv | AT talaldahhan clinicalandechocardiographicpredictorsofmortalityinacutepulmonaryembolism AT irfansiddiqui clinicalandechocardiographicpredictorsofmortalityinacutepulmonaryembolism AT victorftapson clinicalandechocardiographicpredictorsofmortalityinacutepulmonaryembolism AT ericjvelazquez clinicalandechocardiographicpredictorsofmortalityinacutepulmonaryembolism AT stephaniesun clinicalandechocardiographicpredictorsofmortalityinacutepulmonaryembolism AT clemontinaadavenport clinicalandechocardiographicpredictorsofmortalityinacutepulmonaryembolism AT zainabsamad clinicalandechocardiographicpredictorsofmortalityinacutepulmonaryembolism AT sudarshanrajagopal clinicalandechocardiographicpredictorsofmortalityinacutepulmonaryembolism |