Elsevier

American Heart Journal

Volume 134, Issue 3, September 1997, Pages 479-487
American Heart Journal

Echocardiography Doppler in pulmonary embolism: Right ventricular dysfunction as a predictor of mortality rate,☆☆,

https://doi.org/10.1016/S0002-8703(97)70085-1Get rights and content

Abstract

To test the hypothesis that right ventricular (RV) systolic dysfunction at the time of diagnosis of pulmonary embolism (PE) is a predictor of mortality rate, 126 consecutive patients with PE were examined with echocardiography Doppler (ED) on the day of diagnosis. RV function was assessed by evaluation of wall motion on a four-point scale. The material was divided into two groups: group A ( n = 56) with normal or slightly reduced RV function and group B ( n = 70) with moderately or severely reduced RV function. The overall mortality rate was 7.9% in the hospital and 15.1% within 1 year. Four deaths occurred in group A and 15 in group B ( p = 0.04). All in-hospital deaths ( n = 10) occurred in group B ( p = 0.002). The variables associated with mortality rate were RV dysfunction and cancer (in-hospital, p = 0.002 and 0.004; 1 year, p = 0.04 and <0.001, respectively). Nine (7.1%) deaths (all in-hospital) were caused by PE. Five of these patients had advanced-stage cancer. The in-hospital mortality rate in patients without cancer was 4%, all from PE and all in group B. In conclusion, RV dysfunction when diagnosis of PE is established is associated with mortality rate. A strategy for risk stratification of patients with PE with ED may be of clinical usefulness. (Am Heart J 1997;134:479-87.)

Section snippets

Study design and patient selection

The investigation followed a prospective study design. The inclusion criteria were (1) patients with clinical suspicion of PE referred for diagnostic investigation at our hospital, (2) diagnosis of PE confirmed by perfusion-ventilation scintigraphy (V-Q scan) and/or pulmonary angiography, and (3) transthoracic ED investigation performed on the same day as for the diagnosis of PE. Patients were then observed for 1 year.

During the period from Aug. 26, 1988, to Jan. 30, 1993, 141 consecutive

Results

During the study period 157 patients referred to our hospital were diagnosed as having PE after V-Q scan and/or pulmonary angiography. In 16 of these patients, an ED investigation could not be performed on the same day. The reason for this was that the diagnosis of PE was not made at the preliminary evaluation of the lung scintigraphy in two patients, and in 14 patients resources of ED investigation were not available on the day of referral. Of the 141 patients included, 11 were excluded as a

Discussion

In this study we have identified two variables associated with an increased risk of death after diagnosis of PE: decreased RV systolic function at the time of diagnosis for PE and the occurrence of cancer. During the in-hospital period a markedly depressed RV wall motion was significantly associated with death. No patient with a normal RV function died during this period. The increase in risk for death related to the variable RV dysfunction was calculated to be nearly six times greater, but the

References (29)

  • GJ Vlahakes et al.

    The pathophysiology of failure in acute right ventricular hypertension: hemodynamic and biochemical correlations

    Circulation

    (1981)
  • S McGinn et al.

    Acute cor pulmonale from pulmonary embolism

    JAMA

    (1935)
  • K Shirato et al.

    Alterations of the left ventricular diastole pressure-segment length relation produced by the pericardium: effects of cardiac distension and afterload reduction in conscious dogs

    Circulation

    (1978)
  • JS Alpert et al.

    Mortality in patients treated for pulmonary embolism

    JAMA

    (1976)
  • Cited by (487)

    • Focused Ultrasonography in Cardiac Arrest

      2023, Emergency Medicine Clinics of North America
    View all citing articles on Scopus

    Supported by grants from the Swedish Heart and Lung Foundation and the Karolinska Institute.

    ☆☆

    Reprint requests: Ary Ribeiro, Department of Clinical Physiology, Thoracic Clinics, Karolinska Hospital, Box 110, 171 76 Stockholm, Sweden.

    0002-8703/97/$5.00 + 0 4/1/83533

    View full text