Prognostic importance of quantitative echocardiographic evaluation in patients suspected of first non-massive pulmonary embolism
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Prognostic importance of quantitative echocardiographic evaluation in patients suspected of first non-massive pulmonary embolism. / Kjaergaard, Jesper; Schaadt, Bente Krogsgaard; Lund, Jens Otto; Hassager, Christian.
In: European Journal of Echocardiography, Vol. 10, No. 1, 2008, p. 89-95.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Prognostic importance of quantitative echocardiographic evaluation in patients suspected of first non-massive pulmonary embolism
AU - Kjaergaard, Jesper
AU - Schaadt, Bente Krogsgaard
AU - Lund, Jens Otto
AU - Hassager, Christian
N1 - Keywords: Aged; Aged, 80 and over; Analysis of Variance; Cohort Studies; Echocardiography, Doppler; Electrocardiography; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Multivariate Analysis; Perfusion Imaging; Probability; Prognosis; Proportional Hazards Models; Pulmonary Embolism; Risk Factors; Sensitivity and Specificity; Severity of Illness Index; Survival Rate; Ventricular Dysfunction, Right
PY - 2008
Y1 - 2008
N2 - AIMS: Patients suspected of acute pulmonary embolism (PE) frequently undergo echocardiography as a part of the initial work-up. Prognostic implication of routine echocardiography in patients suspected of PE remain to be established. METHODS AND RESULTS: Transthoracic echocardiography, including tissue Doppler imaging, was performed in 283 consecutive patients referred for ventilation/perfusion scintigraphy (V/Q scan) on suspicion of first non-massive PE. The prognostic information of quantitative measures of right ventricular (RV) size, function, and pressure was assessed. Patients with PE had a follow-up echocardiography after 1 year and changes in the parameters were assessed. Patients with PE and normal V/Q scans had similar age-adjusted 1 year mortality [10 and 12%, NS (not significant)], although patients with indeterminate scans carried a poorer prognosis (16% survival, P=0.0004). Among all patients left ventricular (LV) ejection fraction as well as shortening of the pulmonary artery (PA) acceleration time (a measure of RV after-load) was associated with increased mortality [hazard ratio (HR)=0.84 per 10 ms increase, P<0.0001]. In patients with confirmed PE, the PA acceleration time is predictive of event-free survival (all-cause mortality and heart failure hospitalizations) adjusted for LV ejection fraction, age, and sex (HR=0.78 per 10 ms increase, P=0.04). Measures of regional myocardial function were not related to outcome in this study, regardless of presence of PE. CONCLUSION: PA acceleration time and LV systolic function are independent predictors of mortality in patients suspected of PE, and are independent predictors of event-free survival in patients with confirmed PE.
AB - AIMS: Patients suspected of acute pulmonary embolism (PE) frequently undergo echocardiography as a part of the initial work-up. Prognostic implication of routine echocardiography in patients suspected of PE remain to be established. METHODS AND RESULTS: Transthoracic echocardiography, including tissue Doppler imaging, was performed in 283 consecutive patients referred for ventilation/perfusion scintigraphy (V/Q scan) on suspicion of first non-massive PE. The prognostic information of quantitative measures of right ventricular (RV) size, function, and pressure was assessed. Patients with PE had a follow-up echocardiography after 1 year and changes in the parameters were assessed. Patients with PE and normal V/Q scans had similar age-adjusted 1 year mortality [10 and 12%, NS (not significant)], although patients with indeterminate scans carried a poorer prognosis (16% survival, P=0.0004). Among all patients left ventricular (LV) ejection fraction as well as shortening of the pulmonary artery (PA) acceleration time (a measure of RV after-load) was associated with increased mortality [hazard ratio (HR)=0.84 per 10 ms increase, P<0.0001]. In patients with confirmed PE, the PA acceleration time is predictive of event-free survival (all-cause mortality and heart failure hospitalizations) adjusted for LV ejection fraction, age, and sex (HR=0.78 per 10 ms increase, P=0.04). Measures of regional myocardial function were not related to outcome in this study, regardless of presence of PE. CONCLUSION: PA acceleration time and LV systolic function are independent predictors of mortality in patients suspected of PE, and are independent predictors of event-free survival in patients with confirmed PE.
U2 - 10.1093/ejechocard/jen169
DO - 10.1093/ejechocard/jen169
M3 - Journal article
C2 - 18579484
VL - 10
SP - 89
EP - 95
JO - European Heart Journal Cardiovascular Imaging
JF - European Heart Journal Cardiovascular Imaging
SN - 2047-2404
IS - 1
ER -
ID: 19868095