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.