Right ventricular dysfunction is superior and sufficient for risk stratification by a pulmonary embolism response team

Several risk stratification tools are available to predict short-term mortality in patients with acute pulmonary embolism (PE). The presence of right ventricular (RV) dysfunction is an independent predictor of mortality and may be a more efficient way to stratify risk for patients assessed by a Pulm...

Full description

Saved in:
Bibliographic Details
Published in:Journal of thrombosis and thrombolysis 2020, Vol.49 (1), p.34-41
Main Authors: Chen, Yu Lin, Wright, Colin, Pietropaoli, Anthony P., Elbadawi, Ayman, Delehanty, Joseph, Barrus, Bryan, Gosev, Igor, Trawick, David, Patel, Dhwani, Cameron, Scott J.
Format: Article
Language:English
Subjects:
Aged
Biomarkers
Biomarkers - blood
Cardiology
Decision making
Embolism
Embolisms
Female
Health risk assessment
Heart
Hematology
Humans
Hypotension
Male
Medicine
Medicine & Public Health
Middle Aged
Mortality
Natriuretic Peptide, Brain - blood
Peptide Fragments - blood
Pulmonary Embolism - blood
Pulmonary Embolism - diagnosis
Pulmonary Embolism - physiopathology
Pulmonary embolisms
Retrospective Studies
Risk Assessment
Severity of Illness Index
Short term
Troponin T - blood
Ventricle
Ventricular Dysfunction, Right - blood
Ventricular Dysfunction, Right - diagnosis
Ventricular Dysfunction, Right - physiopathology
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Several risk stratification tools are available to predict short-term mortality in patients with acute pulmonary embolism (PE). The presence of right ventricular (RV) dysfunction is an independent predictor of mortality and may be a more efficient way to stratify risk for patients assessed by a Pulmonary Embolism Response Team (PERT). We evaluated 571 patients presenting with acute PE, then stratified them by the pulmonary embolism severity index (PESI), by the BOVA score, or categorically as low risk (no RV dysfunction by imaging), intermediate risk/submassive (RV dysfunction by imaging), or high risk/massive PE (RV dysfunction with sustained hypotension). Using imaging data to firstly define the presence of RV strain, and plasma cardiac biomarkers as additional evidence for myocardial dysfunction, we evaluated whether PESI, BOVA, or RV strain by imaging were more appropriate for determining patient risk by a PERT where rapid decision making is important. Cardiac biomarkers poorly distinguished between PESI classes and BOVA stages in patients with acute PE. Cardiac TnT and NT-proBNP easily distinguished low risk from submassive PE with an area under the curve (AUC) of 0.84 (95% CI 0.73–0.95, p 
ISSN:0929-5305
1573-742X
DOI:10.1007/s11239-019-01922-w