Role of echocardiographic indicators of right ventricular dysfunction in predicting 30-day mortality in non-high- -risk patients with acute pulmonary embolism in different variants of the Bova score.

Background: The Bova score is a validated tool for short-term mortality risk stratification in normotensive patients with acute pulmonary embolism (PE). The prognostic value of echocardiographic parameters in this group of patients remains controversial.

Aims: We aimed to assess the role of echocardiographic indicators of right ventricular dysfunction in different variants of the Bova score.

Methods: Patients with PE confirmed by computed tomography pulmonary angiography had a transthoracic echocardiogram performed during the first day of hospitalization and 30-day follow-up.

Results: One hundred eleven consecutive subjects with non-high-risk PE entered the analysis - 55 men (49.6%), at a median age of 69 (58-79) years; 12 patients died during the 30-day follow-up. Among 3 Bova score variants with different echocardiographic criteria used in practice, the original one AD 2014 had the best but, objectively, poor predictive strength - the area under the curve (AUC) of 0.679. The Bova score with the right-to-left ventricle ratio >1 and tricuspid annular plane systolic excursion <16 mm was an even worse indicator (AUC 0.652), whereas the Bova score with free wall longitudinal strain >-19% and Bova 60/60 sign had fair predictability (AUC 0.701 and 0.731, respectively). Still, they were inferior to the simplified Pulmonary Embolism Severity Index (sPESI, AUC - 0.815). The subjects with Bova score variants with points >4 had a higher risk of death (hazard risk of 1.43-1.59) and with an sPESI ≥1 point had a hazard risk of 2.02.

Conclusions: Various echocardiographic markers of right ventricular dysfunction within divergent variants of the Bova score yield different prediction strengths but are all inferior to the sPESI score.