Low Stroke Volume Predicts Deterioration in Intermediate-Risk Pulmonary Embolism: Prospective Study.

Area of Science:

• Cardiology
• Pulmonary Medicine
• Medical Imaging

Background:

• Prognosis and management of intermediate-risk pulmonary embolism (PE) present significant clinical challenges.
• Identifying patients at higher risk of deterioration or death is crucial for timely intervention.

Purpose of the Study:

• To investigate if stroke volume (SV) can identify intermediate-risk PE patients at increased risk of clinical deterioration or PE-related death.
• To compare echocardiographic measurements between patients receiving escalated interventions versus anticoagulation monotherapy.

Main Methods:

• Retrospective analysis of 370 intermediate-risk PE patients from an 11-emergency department registry.
• Echocardiographic measurements included right ventricle (RV) size, tricuspid annular plane systolic excursion (TAPSE), and stroke volume (SV) via Doppler or 2D methods.
• Primary outcome: composite of PE-related death, cardiac arrest, hypotension requiring catecholamines, or emergency respiratory intervention.

Main Results:

• Lower mean SV (by MOD and Doppler) and TAPSE were observed in patients who experienced the primary outcome.
• SV was the best echocardiographic predictor of the primary outcome (odds ratio 0.72).
• Patients receiving escalated interventions had significantly lower SV, greater RV dilatation, and reduced RV systolic function compared to those on anticoagulation alone.

Conclusions:

• Low stroke volume is a significant predictor of clinical deterioration and mortality in intermediate-risk PE.
• Echocardiographic assessment of SV can identify a subset of intermediate-risk PE patients who may benefit from escalated interventions.