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. 2019 Jan-Dec:25:1076029619886062.
doi: 10.1177/1076029619886062.

Right Ventricular Outflow Doppler Predicts Low Cardiac Index in Intermediate Risk Pulmonary Embolism

Yevgeniy Brailovsky  1 , Vladimir Lakhter  2 , Ido Weinberg  2 , Katerina Porcaro  1 , Jeremiah Haines  3 , Stephen Morris  3 , Dalila Masic  4 , Erin Mancl  4 , Riyaz Bashir  5 , Mohamad Alkhouli  6 , Kenneth Rosenfield  2 , Verghese Mathew  1 , John Lopez  1 , Carlos F Bechara  7 , Cara Joyce  8 , Jawed Fareed  9 , Amir Darki  1
Affiliations

Right Ventricular Outflow Doppler Predicts Low Cardiac Index in Intermediate Risk Pulmonary Embolism

Yevgeniy Brailovsky et al. Clin Appl Thromb Hemost. 2019 Jan-Dec.

Abstract

Intermediate-risk pulmonary embolism (PE) has variable outcomes. Current risk stratification models lack the positive predictive value to identify patients at highest risk of PE-related mortality. We identified intermediate-risk PE patients who underwent catheter-based interventions and right heart catheterization (RHC) and identified those with low cardiac index (CI < 2.2 L/min/m2). We utilized regression models to identify echocardiographic predictors of low CI and Kaplan Meier curve to evaluate PE-related mortality when stratified by the echocardiographic predictor. Of 174 intermediate-risk PE patients, 41 underwent RHC. Within this cohort, 46.3% had low CI. Univariable linear regression identified right ventricular outflow tract velocity time integral (RVOT VTI), right/left ventricular ratio, S prime, inferior vena cava diameter, and pulmonary artery systolic pressure as potential predictors of low CI. Multivariable linear regression identified RVOT VTI as significant predictor of low CI (β coefficient 0.124, 95% confidence interval [CI]: 0.01-0.24, P = .034). Right ventricular outflow tract velocity time integral <9.5 cm was associated with increased PE-related mortality, P = .002. A substantial proportion of intermediate-risk PE patients referred for catheter-based interventions had low CI despite normotension. Right ventricular outflow tract velocity time integral was a significant predictor of low CI. Low RVOT VTI was associated with increased PE-related mortality.

Keywords: cardiac index; cardiogenic shock; pulmonary embolism; thrombolysis.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow diagram of the methodology of the study.
Figure 2.
Figure 2.
A, Echocardiographic parasternal short axis view at the base of the heart with a pulse wave doppler at the level of the pulmonic valve (PV; as demonstrated by illustrative white line) (B) representative example of the RVOT spectral doppler with low VTI. PA indicates pulmonary artery; PV, pulmonic valve; RA, right atrium, TV, tricuspid valve, RVOT, right ventricular outflow tract, VTI, velocity time integral.
Figure 3.
Figure 3.
Receiver operating characteristic (ROC) curve for RVOT VTI for the diagnosis of low cardiac index (CI < 2.2 L/min/m2). Area under the curve (AUC) is 0.78, P = .006 Cutoff RVOT VTI (right ventricular outflow tract velocity time integral) of 9.5 cm provides sensitivity of 74% and specificity of 77%.
Figure 4.
Figure 4.
Kaplan-Meier curve of PE-related mortality. Right ventricular outflow tract velocity time integral of 9.5 cm serves as a discriminator between the 2 groups. Right ventricular outflow tract velocity time integral indicates right ventricular outflow tract velocity time integral.
See this image and copyright information in PMC

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