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

• 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
• ISSN: 0929-5305; 1573-742X
• DOI: 10.1007/s11239-019-01922-w

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