European Journal of Echocardiography Advance Access originally published online on May 25, 2008
European Journal of Echocardiography 2009 10(1):89-95; doi:10.1093/ejechocard/jen169
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Prognostic importance of quantitative echocardiographic evaluation in patients suspected of first non-massive pulmonary embolism
1 Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
2 Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
3 Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Gentofte, Hellerup, Denmark
Received 19 February 2008; accepted after revision 26 April 2008; online publish-ahead-of-print 25 May 2008.
* Corresponding author. Tel: +45 35453545; fax: +45 35452513. E-mail address: jesper.kjaergaard{at}rh.regionh.dk
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Abstract |
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Aims: Patients suspected of acute pulmonary embolism (PE) frequently undergo echocardiography as a part of the initial work-up. Prognostic implication of routine echocardiography in patients suspected of PE remain to be established.
Methods and results: Transthoracic echocardiography, including tissue Doppler imaging, was performed in 283 consecutive patients referred for ventilation/perfusion scintigraphy (V/Q scan) on suspicion of first non-massive PE. The prognostic information of quantitative measures of right ventricular (RV) size, function, and pressure was assessed. Patients with PE had a follow-up echocardiography after 1 year and changes in the parameters were assessed.
Patients with PE and normal V/Q scans had similar age-adjusted 1 year mortality [10 and 12%, NS (not significant)], although patients with indeterminate scans carried a poorer prognosis (16% survival, P = 0.0004). Among all patients left ventricular (LV) ejection fraction as well as shortening of the pulmonary artery (PA) acceleration time (a measure of RV after-load) was associated with increased mortality [hazard ratio (HR) = 0.84 per 10 ms increase, P < 0.0001].
In patients with confirmed PE, the PA acceleration time is predictive of event-free survival (all-cause mortality and heart failure hospitalizations) adjusted for LV ejection fraction, age, and sex (HR = 0.78 per 10 ms increase, P = 0.04).
Measures of regional myocardial function were not related to outcome in this study, regardless of presence of PE.
Conclusion: PA acceleration time and LV systolic function are independent predictors of mortality in patients suspected of PE, and are independent predictors of event-free survival in patients with confirmed PE.
Keywords: Pulmonary embolism; Perfusion scintigraphy; Echocardiography; Right ventricle; Ventricular function