Clinical Risk Assessment of Acute Intermediate-Risk Pulmonary Embolism Using Repeat Transthoracic Echocardiography

Area of Science:

• Cardiology
• Pulmonary Medicine
• Diagnostic Imaging

Background:

• Current risk stratification for intermediate-risk pulmonary embolism (PE) is insufficient for identifying patients needing escalated care interventions (ECIs).
• Existing algorithms do not incorporate dynamic assessments of right ventricular (RV) function over time.

Purpose of the Study:

• To determine if changes in tricuspid annular plane systolic excursion (TAPSE) on serial transthoracic echocardiography (TTE) correlate with clinical outcomes in acute intermediate-risk PE.
• To evaluate the utility of repeat TTE in predicting outcomes before ECIs.

Main Methods:

• Retrospective analysis of acute intermediate-risk PE patients with at least two TTE studies before ECIs.
• Patients were categorized into 'worsening' (ΔTAPSE < 0 mm) and 'stable/improving' (ΔTAPSE ≥ 0 mm) RV function cohorts.
• Primary outcome was 30-day mortality; secondary outcomes included 90-day mortality, intubation, ICU admission, vasopressor use, and ECIs.

Main Results:

• Eighty-eight patients were analyzed (38 worsening, 50 stable/improving).
• Worsening TAPSE was linked to significantly higher risks of 30-day mortality (RR 5.26), 90-day mortality (RR 3.01), and intubation (RR 1.86).
• Each 1 mm increase in ΔTAPSE reduced 30-day mortality odds (OR 0.86); patients with initially preserved TAPSE (≥16 mm) who showed decline had higher 30-day mortality (33.3% vs. 8.7%).

Conclusions:

• Deterioration in RV function, assessed by serial TTE, is associated with increased short-term mortality in intermediate-risk PE.
• Serial RV function assessment may enhance risk stratification, even in patients with initially normal function.
• Prospective studies are needed to confirm the impact of serial RV function monitoring on treatment decisions and patient outcomes.