Right Ventricular Strain and Outflow Tract Velocity Time Integral Are Associated with Mortality in Critically Ill Patients with Pulmonary Embolism.

IF 19.3 1区医学 Q1 CRITICAL CARE MEDICINE

American journal of respiratory and critical care medicine Pub Date : 2025-03-28 DOI:10.1164/rccm.202407-1433OC

Manuel Ruiz-Bailén, Javier Hidalgo-Martín, José Ángel Ramos Cuadra, Julia Manetsberger, Maria Dolores Pola Gallego de Guzmán, Miguel Ángel Díaz-Castellanos, Patricia Casado-Santa-Bárbara, Johannes Dagomar Lohman, Antonio Cárdenas-Cruz, Fernando Clau-Terré, María Leyre Lavilla-Lerma

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引用次数: 0

Abstract

Introduction: High-risk pulmonary thromboembolism (PE) is often fatal due to right ventricular heart failure. However, right ventricular echocardiographic parameters that are associated with adverse outcome in PE are incompletely characterized. Our objective was to evaluate if right ventricular global longitudinal strain (RVGLS) and right ventricular outflow tract velocity-time integral (RVOT VTI) might be indicators of mortality in PE.

Methodology: This is an observational study with prospective inclusion from June 1999 to December 2023. Only patients with PE requiring intensive care medicine (ICU) admission were included. The study assessed mortality in the ICU and at 6 months of follow-up, as well as the development of heart failure. The independent variables included clinical and echocardiographic characteristics.

Results: A total of 463 PE patients with a mean age of 62.3 ± 21.6 years were included in this study. The ICU and 6-month mortality were 18.4% and 20.7%, respectively. 386 patients were treated with thrombolysis. Multivariable analysis showed that the variables associated with ICU mortality were Pulmonary embolism severity index (PESI) (OR 1.241, 95% CI [1.037-1.587], p<0.001), RVGLS (OR 0.421, 95% CI [0.202-0.774], p<0.001), left atrial reservoir (εs) (OR 0.357, 95% CI [0.141-0.756], p<0.001), right atrial pump (εa) (OR 0.632, 95% CI [0.282-0.887]), the RVOT VTI (OR 0.678, 95% CI [0.321-0.881], p<0.001), and left ventricular outflow tract (LVOT) VTI (OR 0.782, 95% CI [0.413-0.912], p<0.001). Multivariable analysis found that the development of heart failure assessed at 6 months was associated with RVGLS (OR 0.538, 95% CI [0.182-0.785], p=0.001), left atrial strain (εa) (OR 0.313, 95% CI [0.21-0.721], p<0.001), right ventricular basal diameter (OR 1.173, 95% CI [1.018 - 1.892], p<0.001), pulmonary flow acceleration time in RVOT (OR 0.693, 95% CI [0.328 - 0.839], p<0.001), estimated pulmonary artery wedge pressure (PAWP) (OR 1.437, 95% CI [1.131- 2.274], p<0.001), and intracavitary thrombus (OR 1.223, 95% CI [1.117 - 1.973], p<0.001). The variables that were associated with 6-month mortality in the multivariable analysis were PESI (OR 1.029, 95% CI [1.012 - 1.377], p<0.001), RVGLS (OR 0.657, 95% CI [0.438-0.871], p<0.001), RVOT VTI (OR 0.324, 95% CI [0.102-0.541], p<0.001), right atrial pump (εa) (OR 0.352, 95% CI [0.193-0.721], p<0.001), and LVOT VTI (OR 0.814, 95% CI [0.281-0.948], p<0.001), all p-values <0.001.

Conclusions: Among patients with PE in the ICU, right ventricular strain and RVOT VTI were associated with mortality in the ICU and at 6-month. Furthermore, right ventricular strain was independently associated with future heart failure. These data emphasize the clinical relevance of right ventricular parameters in prognosticating high-risk PE.

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危重肺栓塞患者右心室应变和流出道速度时间积分与死亡率相关。

高危肺血栓栓塞（PE）往往是致命的，由于右心室心力衰竭。然而，与PE不良结果相关的右心室超声心动图参数尚未完全表征。我们的目的是评估右心室整体纵向应变（RVGLS）和右心室流出道速度-时间积分（RVOT VTI）是否可能是PE死亡率的指标。方法：这是一项观察性研究，前瞻性纳入时间为1999年6月至2023年12月。仅纳入需要重症监护医学（ICU）入院的PE患者。该研究评估了ICU和随访6个月时的死亡率，以及心力衰竭的发展情况。自变量包括临床和超声心动图特征。结果：共纳入PE患者463例，平均年龄62.3±21.6岁。ICU和6个月死亡率分别为18.4%和20.7%。386例患者接受溶栓治疗。多变量分析显示，与ICU死亡率相关的变量为肺栓塞严重程度指数（PESI）（OR 1.241, 95% CI [1.037 ~ 1.587], p）。结论：在ICU PE患者中，右室劳损和RVOT VTI与ICU和6个月时的死亡率相关。此外，右心室劳损与未来心力衰竭独立相关。这些数据强调了右心室参数在预测高危PE中的临床相关性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of respiratory and critical care medicine 医学-呼吸系统

CiteScore

27.30

自引率

4.50%

发文量

1313

审稿时长

3-6 weeks

期刊介绍： The American Journal of Respiratory and Critical Care Medicine focuses on human biology and disease, as well as animal studies that contribute to the understanding of pathophysiology and treatment of diseases that affect the respiratory system and critically ill patients. Papers that are solely or predominantly based in cell and molecular biology are published in the companion journal, the American Journal of Respiratory Cell and Molecular Biology. The Journal also seeks to publish clinical trials and outstanding review articles on areas of interest in several forms. The State-of-the-Art review is a treatise usually covering a broad field that brings bench research to the bedside. Shorter reviews are published as Critical Care Perspectives or Pulmonary Perspectives. These are generally focused on a more limited area and advance a concerted opinion about care for a specific process. Concise Clinical Reviews provide an evidence-based synthesis of the literature pertaining to topics of fundamental importance to the practice of pulmonary, critical care, and sleep medicine. Images providing advances or unusual contributions to the field are published as Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences. A recent trend and future direction of the Journal has been to include debates of a topical nature on issues of importance in pulmonary and critical care medicine and to the membership of the American Thoracic Society. Other recent changes have included encompassing works from the field of critical care medicine and the extension of the editorial governing of journal policy to colleagues outside of the United States of America. The focus and direction of the Journal is to establish an international forum for state-of-the-art respiratory and critical care medicine.