Left Ventricular Dysfunction Correlates With Mortality in Pulmonary Embolism |
| |
| Authors: | Andrew S Liteplo Calvin K Huang Hui Zheng Ravish Patel Daniel Ratanski Nicholas J Giordano Christopher Kabrhel Hamid Shokoohi |
| |
| Institution: | 1. Massachusetts General Hospital, Boston, Massachusetts;2. Harvard Medical School, Boston, Massachusetts;3. Augusta University/University of Georgia Medical Partnership, University of Georgia, Athens, Georgia;4. Northeastern University, Boston, Massachusetts;1. Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas;2. Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas;1. University of Maryland School of Medicine, Baltimore, Maryland;2. The Research Associate Program in Emergency Medicine and Critical Care, University of Maryland School of Medicine, Baltimore, Maryland;3. University of Maryland, Baltimore County, Baltimore, Maryland;4. Ocean City Beach Patrol, Ocean City, Maryland;5. Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland;1. Department of Emergency Medicine, Wright State University Boonshoft School of Medicine, Dayton, Ohio;2. University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, Texas;3. McGovern Medical School at UTHealth, Houston, Texas;4. Baylor College of Medicine, Houston, Texas;1. Pediatric Emergency and Intensive Care Units, Post Graduate Institute of Medical Education and Research, Chandigarh, India;2. Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India;1. Department Ophthalmology and Vision Sciences, Toronto, Ontario, Canada;2. Faculty of Medicine, University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada |
| |
| Abstract: | BackgroundRisk stratification of patients with pulmonary embolism (PE) is essential to guide advanced interventional management and proper disposition.ObjectivesIn this study, we sought to assess individual echocardiographic markers of right ventricular (RV) strain and left ventricular (LV) function in patients with high-risk PE and identify their association with the need for advanced intervention (such as thrombolysis) and 30-day mortality.MethodsThis was a retrospective study of ED patients with PE who were subject to a pulmonary embolism response team activation over a 5-year period. Cardiac point-of-care ultrasound studies were performed as part of patient care and later assessed for septal bowing, RV hypokinesis, McConnell sign, RV enlargement, tricuspid annular place systolic excursion, and LV systolic dysfunction. Outcome variables included need for advanced intervention and 30-day mortality.ResultsThe pulmonary embolism response team was activated in 893 patients, of which 718 had a confirmed PE. Of these, 90 had adequate cardiac point-of-care ultrasound images available for review. Patients who needed an advanced intervention were more likely to have septal bowing (odds ratio OR] 8.69, 95% confidence interval CI] 2.37–31.86), RV enlargement (OR 4.02, 95% CI 1.43–11.34), and a McConnell sign (OR 2.79, 95% CI 1.09–7.13). LV dysfunction was the only statistically significant predictor of 30-day mortality (OR 9.63, 95% CI 1.74–53.32).ConclusionIn patients with PE in the ED, sonographic findings of RV strain that are more commonly associated with advanced intervention included septal bowing, McConnell sign, and RV enlargement. LV dysfunction was associated with a higher 30-day mortality. These findings can help inform decisions about ED management and disposition of patients with PE. |
| |
| Keywords: | left ventricular function mortality point-of-care ultrasound pulmonary embolism right ventricular strain ultrasound |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
