Four-Chamber Myocardial Strain to Predict Mortality in Patients With Pulmonary Embolism

Echocardiography in patients with acute pulmonary embolism (PE) primarily focuses on right ventricular (RV) function. The involvement of other heart cavities have been less studied, especially regarding their potential effect on prognosis. In this study we assessed the additional prognostic value of 4-chamber myocardial strain beyond usual risk scores during follow-up.

This retrospective cohort study included 488 patients hospitalized for PE.

During a median follow-up of 3.6 years, all-cause death (primary outcome) occurred in 93/488 patients (19.1%). At baseline, increasing PE severity across the 4 European Society of Cardiology (ESC) risk groups was significantly associated with reductions in left atrial (LA), right atrial (RA), and absolute values of biventricular strains (all P < 0.001, except RA contractile strain, P = 0.052). In multivariable analysis, left ventricular global longitudinal strain (> -19.1%), RV free wall strain (> -19.1%), RA reservoir strain (< 27.5%), RA conduit strain (< 16.0%), LA reservoir strain (< 36.4%), and LA conduit strain (< 16.6%) predicted all-cause death independently from body mass index, ESC risk score, and B-type natriuretic peptide and C-reactive protein levels. Using receiver-operating characteristic analysis, ESC risk score had the lowest area under the curve to predict all-cause mortality risk whereas a combined approach including clinical, biological, and echocardiography with strain parameters had the highest predictive value.

Beyond RV remodelling and dysfunction, patients with acute PE might exhibit alterations in myocardial strain across all 4 cardiac chambers, which could serve as important predictors of all-cause mortality, in addition to conventional echocardiographic parameters.