This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (51)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Venous Thromboembolism  • Cardiovascular System  • Prognosis/ Outcomes  • Echocardiography  • Cardiac Diagnostic Tests  • Alert me on articles by topic  Social Bookmarking   What's this?

Nils Kucher, MD; Elisa Rossi, BS; Marisa De Rosa, PhD; Samuel Z. Goldhaber, MD

Arch Intern Med. 2005;165:1777-1781.

Background  The prognostic role of echocardiographic right ventricular (RV) dysfunction for predicting mortality in patients with acute pulmonary embolism and a preserved systemic arterial pressure remains controversial.

Methods  We evaluated 1035 patients with pulmonary embolism from the International Cooperative Pulmonary Embolism Registry who (1) presented with systolic systemic arterial pressure of 90 mm Hg or higher and (2) who underwent echocardiography within 24 hours of a diagnosis of pulmonary embolism, showing presence (n = 405) or absence (n = 630) of RV hypokinesis. The main outcome measure was the cumulative survival rate through 30 days in patients with and without RV hypokinesis.

Results  In patients with RV hypokinesis, the initial systolic systemic pressure was lower (125 ± 22 mm Hg vs 131 ± 22 mm Hg; P<.001), and the initial heart rate was higher (104 ± 21 beats per minute vs 99 ± 22 beats per minute; P<.001) than in patients without RV hypokinesis. Cancer was less often present (14.1% vs 22.5%, P = .001). The 30-day survival rates in patients with and without RV hypokinesis were 83.7% (95% confidence interval [CI], 79.3%-87.0%) and 90.6% (95% CI, 88.0%-92.6%), respectively (log-rank P value <.001). The univariate hazard ratio of RV hypokinesis for predicting 30-day mortality was 2.11 (95% CI, 1.41-3.16; P<.001). Right ventricular hypokinesis remained an independent predictor of 30-day mortality (hazard ratio, 1.94; 95% CI, 1.23-3.06) after adjusting for univariately significant predictors, including cancer, congestive heart failure, chronic lung disease, age older than 70 years, systolic arterial pressure of 100 mm Hg or lower, administration of thrombolytic therapy, and heart rate greater than 100 beats per minutes.

Conclusion  Among patients with pulmonary embolism who present with a systolic arterial pressure greater than or equal to 90 mm Hg, echocardiographic RV hypokinesis is an independent predictor of early death.

Author Affiliations: Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass (Drs Kucher and Goldhaber); and CINECA, Bologna, Italy (Ms Rossi and Dr De Rosa).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Diagnosis and Initial Treatment of Venous Thromboembolism in Patients With Cancer
Streiff
JCO 2009;27:4889-4894.
ABSTRACT | FULL TEXT  

Massaging the outcome: an unusual presentation of pulmonary embolism
Lim et al.
BMJ Case Reports 2009;2009:bcr0120091505-bcr0120091505.
ABSTRACT | FULL TEXT  

Prognostic importance of quantitative echocardiographic evaluation in patients suspected of first non-massive pulmonary embolism
Kjaergaard et al.
Eur J Echocardiogr 2009;10:89-95.
ABSTRACT | FULL TEXT  

Acute Pulmonary Embolism
Konstantinides
NEJM 2008;359:2804-2813.
FULL TEXT  

Acute pulmonary embolism revisited
Konstantinides
Postgrad. Med. J. 2008;84:651-658.
FULL TEXT  

Role of thrombolysis in haemodynamically stable patients with pulmonary embolism
Proudfoot et al.
Thorax 2008;63:853-854.
FULL TEXT  

Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)
Authors/Task Force Members et al.
Eur Heart J 2008;29:2276-2315.
FULL TEXT  

Quantification of right ventricular function in acute pulmonary embolism: relation to extent of pulmonary perfusion defects
Kjaergaard et al.
Eur J Echocardiogr 2008;9:641-645.
ABSTRACT | FULL TEXT  

Combined Clot Fragmentation and Aspiration in Patients With Acute Pulmonary Embolism
Eid-Lidt et al.
Chest 2008;134:54-60.
ABSTRACT | FULL TEXT  

Acute pulmonary embolism revisited
Konstantinides
Heart 2008;94:795-802.
FULL TEXT  

Growth Differentiation Factor-15 for Prognostic Assessment of Patients with Acute Pulmonary Embolism
Lankeit et al.
Am. J. Respir. Crit. Care Med. 2008;177:1018-1025.
ABSTRACT | FULL TEXT  

Assessing the Prognosis of Acute Pulmonary Embolism: Tricks of the Trade
Goldhaber
Chest 2008;133:334-336.
FULL TEXT  

Prognostic Value of Echocardiographic Right/Left Ventricular End-Diastolic Diameter Ratio in Patients With Acute Pulmonary Embolism*: Results From a Monocenter Registry of 1,416 Patients
Fremont et al.
Chest 2008;133:358-362.
ABSTRACT | FULL TEXT  

Interval Increase in Right-Left Ventricular Diameter Ratios at CT as a Predictor of 30-day Mortality after Acute Pulmonary Embolism: Initial Experience
Lu et al.
Radiology 2008;246:281-287.
ABSTRACT | FULL TEXT  

Haemodynamically unstable pulmonary embolism in the RIETE Registry: systolic blood pressure or shock index?
Otero et al.
Eur Respir J 2007;30:1111-1116.
ABSTRACT | FULL TEXT  

Functional limitation and right ventricular dysfunction at 6-month follow-up in patients with non-massive pulmonary embolism: useful outcomes for testing therapy of acute submassive pulmonary embolism?
Palmieri et al.
Eur Heart J 2007;28:2430-2431.
FULL TEXT  

Percutaneous Mechanical Thrombectomy for Acute Pulmonary Embolism: A Double-Edged Sword
Goldhaber
Chest 2007;132:363-365.
FULL TEXT  

Prognostic Value of Troponins in Acute Pulmonary Embolism: A Meta-Analysis
Becattini et al.
Circulation 2007;116:427-433.
ABSTRACT | FULL TEXT  

Pulmonary Embolism in the Critically Ill
Carlbom and Davidson
Chest 2007;132:313-324.
ABSTRACT | FULL TEXT  

Heart-type fatty acid-binding protein permits early risk stratification of pulmonary embolism
Puls et al.
Eur Heart J 2007;28:224-229.
ABSTRACT | FULL TEXT  

Thinking Outside the Box
Jaitovich et al.
NEJM 2006;355:851-852.
FULL TEXT  

Acute Pulmonary Embolism: Part II: Treatment and Prophylaxis
Piazza and Goldhaber
Circulation 2006;114:e42-e47.
FULL TEXT  

Acute Pulmonary Embolism: Part I: Epidemiology and Diagnosis
Piazza and Goldhaber
Circulation 2006;114:e28-e32.
FULL TEXT  

Echocardiography in the Emergency Department
Van Dantzig
SEMIN CARDIOTHORAC VASC ANESTH 2006;10:79-81.
ABSTRACT  

Massive Pulmonary Embolism
Kucher et al.
Circulation 2006;113:577-582.
ABSTRACT | FULL TEXT  

Invited Commentary
Balachandran et al.
RadioGraphics 2006;26:39-40.
FULL TEXT  

Extended enoxaparin monotherapy for acute symptomatic pulmonary embolism
Kucher et al.
Vasc Med 2005;10:251-256.
ABSTRACT  

Thrombolytic Therapy for Patients With Pulmonary Embolism Who Are Hemodynamically Stable But Have Right Ventricular Dysfunction: Pro
Goldhaber
Arch Intern Med 2005;165:2197-2199.
FULL TEXT