Pulmonary embolism (PE) ranks as the third leading cause of cardiovascular death, following myocardial infarction and stroke. The European Society of Cardiology (ESC) guidelines emphasize the importance of short-term prognostic stratification for PE based on right ventricular (RV) overload, which can be detected through transthoracic echocardiography (TTE) or contrast-enhanced chest CT. This study aimed to identify which indicators of right ventricular dysfunction most accurately predict in-hospital mortality (IHM) among patients diagnosed with PE.
Conducted as a monocentric retrospective study, the research included adult patients admitted through the emergency department with a contrast-enhanced CT confirmed diagnosis of PE between January 2018 and December 2022, all of whom underwent a TTE within 48 hours of diagnosis. A total of 509 patients (median age 76 years) were included, with an observed IHM rate of 7.1%. Univariate analysis revealed that several factors correlated significantly with IHM: an RV/LV ratio greater than 1 (odds ratio [OR] 2.23), tricuspid annular plane systolic excursion (TAPSE) less than 17 mm (OR 4.73), a D-shaped left ventricle (OR 3.73), and left ventricular ejection fraction (LVEF) less than 35% (OR 5.78). However, in the multivariate analysis, which also considered hemodynamic instability, PESI class greater than II, and abnormal high-sensitivity cardiac troponin I (hs-cTnI) levels, only LVEF less than 35% emerged as an independent predictor of IHM (OR 5.46).
This study concludes that while TTE is vital for the initial management of patients with suspected PE and circulatory shock, signs of RV dysfunction are poor indicators of IHM, whereas severely reduced LVEF serves as a significant risk factor for in-hospital mortality.
