Prognostic Value of Echocardiographic Right/Left Ventricular End-Diastolic Diameter Ratio in Patients With Acute Pulmonary Embolism: Results From a Monocenter Registry of 1,416 Patients

doi:10.1378/chest.07-1231

Chest

Volume 133, Issue 2, February 2008, Pages 358-362

https://doi.org/10.1378/chest.07-1231 Get rights and content

Background

In the literature, echocardiographic assessment of the prognosis of acute pulmonary embolism is based on analysis of right ventricle free-wall motion or on a composite index combining right ventricular dilatation, paradoxical septal wall motion, and pulmonary hypertension. The aim of this study was to determine the prognostic value of a single quantitative echocardiographic criterion, the right/left ventricular end-diastolic diameter (RV/LV) ratio.

Methods

Registry data on 1,416 consecutive patients hospitalized for acute pulmonary embolism were used to study retrospectively a population of 950 patients who underwent echocardiographic assessment on hospital admission and for whom the RV/LV ratio was available.

Results

The hospital mortality rate for the series was 3.3%. Sensitivity and specificity of RV/LV ratio ≥ 0.9 for predicting hospital mortality were 72% and 58%, respectively. Multivariate analysis showed the independent predictive factors for hospital mortality to be the following: systolic BP < 90 mm Hg (odds ratio [OR], 10.73; p < 0.0001), history of left heart failure (OR, 8.99; p < 0.0001), and RV/LV ratio ≥ 0.9 (OR, 2.66; p = 0.01).

Conclusions

In our retrospective series, an echocardiographic RV/LV ratio ≥ 0.9 was shown to be an independent predictive factor for hospital mortality. This criterion may be of value in selecting cases of submassive pulmonary embolism with a poor prognosis that are liable to benefit from thrombolytic treatment.

Section snippets

Patients

Study data are from Trousseau hospital (Tours, France) pulmonary embolism registry data for January 1, 1992, through June 30, 2005. Inclusion criteria were as follows: (1) patients presenting with pulmonary embolism confirmed by high-probability ventilation-perfusion lung scan as per the criteria defined by the Prospective Investigation of Pulmonary Embolism Diagnosis study,¹⁸ or accompanied by venous Doppler ultrasound confirming vein thrombosis for the other cases; pulmonary angiography; or

Results

In the registry of 1,416 consecutive patients hospitalized for pulmonary embolism, 1,084 patients underwent echocardiography on hospital admission. The study population consisted of the 950 patients for whom the echocardiographic RV/LV ratio was available. Characteristics of the study population and of the excluded patients group are shown in Table 1 .

In the study group of patients with RV/LV ratio available, mean age was 69 ± 14 years. Women predominated (sex ratio, 0.66). More than a third of

Discussion

The mortality rate of this series of 950 patients was low compared to that in other published registries: 3.3% vs 22.5% in Management Strategies and Prognosis in Patients With Pulmonary Embolism (MAPPET) registry,²⁰ and 15.3% in the International Cooperative Pulmonary Embolism Registry (ICOPER).¹⁰ Selection bias does not seem to underlie this marked difference because the in-hospital mortality rate of the 466 excluded patients is equivalent (3.9%, p = 0.53). In addition to the fact that the

Conclusion

This monocentric retrospective study of 950 patients shows the value of the echocardiographic RV/LV ratio in the prognostic evaluation of pulmonary embolism. The critical cutoff for hospital mortality prediction was 0.9. The prognostic value of that easily determined echocardiographic parameter is independent of patient history and clinical data. In the future, RV/LV ratio could be used to screen clinically stable patients in order to detect patients at high risk, for whom the value of

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This study was conducted at the Trousseau Hospital, Tours, France.

The authors have no conflicts of interest with regard to this publication to disclose.

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Original ResearchPulmonary EmbolismPrognostic Value of Echocardiographic Right/Left Ventricular End-Diastolic Diameter Ratio in Patients With Acute Pulmonary Embolism: Results From a Monocenter Registry of 1,416 Patients

Background

Methods

Results

Conclusions

Section snippets

Patients

Results

Discussion

Conclusion

Lancet

Chest

Am J Cardiol

Lancet

Am Heart J

Am J Cardiol

Chest

J Am Coll Cardiol

Incidence of venous thromboembolism: a community-based study in Western France

Thromb Haemost

Guidelines on diagnosis and management of acute pulmonary embolism

Eur Heart J

Original Research
Pulmonary Embolism
Prognostic Value of Echocardiographic Right/Left Ventricular End-Diastolic Diameter Ratio in Patients With Acute Pulmonary Embolism: Results From a Monocenter Registry of 1,416 Patients