Wiliński Jerzy, Chukwu Ositadima, Skwarek Anna, Borek Radosław, Medygrał Michał, Chukwu Julia, Stolarz-Skrzypek Katarzyna, Rajzer Marek
Department of Internal Medicine with Cardiology Subdivision, Blessed Marta Wiecka District Hospital, Bochnia, Poland.
Center for Invasive Cardiology, Electrotherapy and Angiology, Intercard LLC, Nowy Sącz, Poland.
Kardiol Pol. 2025;83(2):171-179. doi: 10.33963/v.phj.103453. Epub 2025 Jan 2.
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.
We aimed to assess the role of echocardiographic indicators of right ventricular dysfunction in different variants of the Bova score.
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.
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.
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.
博瓦评分是用于血压正常的急性肺栓塞（PE）患者短期死亡风险分层的有效工具。超声心动图参数在这类患者中的预后价值仍存在争议。
我们旨在评估右心室功能障碍的超声心动图指标在不同博瓦评分变体中的作用。
经计算机断层扫描肺动脉造影确诊为PE的患者在住院第一天和30天随访期间进行经胸超声心动图检查。
111例连续的非高危PE患者纳入分析，其中55例男性（49.6%），中位年龄69岁（58 - 79岁）；12例患者在30天随访期间死亡。在实践中使用的具有不同超声心动图标准的3种博瓦评分变体中，2014年的原始版本表现最佳，但客观上预测强度较差，曲线下面积（AUC）为0.679。右心室与左心室比值>1且三尖瓣环平面收缩期位移<16 mm的博瓦评分是更差的指标（AUC 0.652），而游离壁纵向应变>-19%且有博瓦60/60征的博瓦评分具有较好的可预测性（AUC分别为0.701和0.731）。然而，它们仍不如简化的肺栓塞严重程度指数（sPESI，AUC - 0.815）。博瓦评分变体得分>4的受试者死亡风险较高（风险比为1.43 - 1.59），而sPESI≥1分的受试者风险比为2.02。
博瓦评分不同变体中各种右心室功能障碍的超声心动图标志物具有不同的预测强度，但均不如sPESI评分。
