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

Hofmann, Eveline; Limacher, Andreas; Méan, Marie; Kucher, Nils; Righini, Marc; Frauchiger, Beat; Beer, Jürg-Hans; Osterwalder, Joseph; Aschwanden, Markus; Matter, Christian M; Banyai, Martin; Egloff, Michael; Hugli, Olivier; Staub, Daniel; Bounameaux, Henri; Rodondi, Nicolas; Aujesky, Drahomir (2016). Echocardiography does not predict mortality in hemodynamically stable elderly patients with acute pulmonary embolism. Thrombosis research, 145, pp. 67-71. Elsevier 10.1016/j.thromres.2016.07.014

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Hofmann, Eveline; Limacher, Andreas; Méan Pascual, Marie; Kucher, Nils; Rodondi, Nicolas and Aujesky, Drahomir

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0049-3848

Publisher:

Elsevier

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

03 Jan 2017 10:25

Last Modified:

11 Sep 2017 19:18

Publisher DOI:

10.1016/j.thromres.2016.07.014

PubMed ID:

27498122

Uncontrolled Keywords:

Echocardiography Mortality Pulmonary embolism

BORIS DOI:

10.7892/boris.92364

URI:

https://boris.unibe.ch/id/eprint/92364

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