Utility of Incorporating Radiological Findings of Right Heart Strain in Patients With Acute Pulmonary Embolism for Risk Stratification of Adverse Outcomes: A Retrospective Analysis.

Abstract

Background: Right heart (RH) strain in the setting of pulmonary embolisms can significantly increase the risk of mortality. Thus, screening for risk of complications in these patients is crucial. The goal of our study was to assess the strength of specific diagnostic findings of RH strain for predicting adverse outcomes including mortality, hospital length of stay, and the requirement of advanced interventions.

Methods: A single-center, retrospective cohort study of 81 patients diagnosed with acute pulmonary embolism with RH strain on computed tomography pulmonary angiogram (CTPA) from September 12, 2019, to August 30, 2023. Data were collected on patient computed tomography findings, transthoracic echocardiogram (TTE) findings, electrocardiogram findings, troponin I, and B-type natriuretic peptide values. Adverse outcomes were recorded including 30-day mortality, increased hospital length of stay, and utilization of advanced therapy (systemic fibrinolysis, catheter-directed therapy, or pulmonary embolectomy). Stepwise regression analysis was performed to model predictors of adverse outcomes in RH strain patients.

Results: Right ventricle (RV) dilation on TTE was significantly associated with 30-day mortality (P = .005). Tricuspid annular plane systolic excursion (TAPSE) of less than 16 mm on TTE was significantly associated with the use of advanced therapy (P = .001). An increased length of hospital stay was significantly associated with right ventricular dilation on TTE (P < .001), renal insufficiency (P = .012), and surgery within 90 days (P = .003). A finding of McConnell's sign on TTE (P = .044) was significantly associated with a higher pulmonary embolism severity index.

Conclusion: Advanced interventions should strongly be considered in patients with a CTPA diagnosis of RH strain who have TTE findings of RV dysfunction including RV dilation, TAPSE less than 16 mm, and McConnell's sign due to the high risk of mortality and morbidity.