Eguchi Shunsuke, Orihara Yoshiyuki, Eguchi Ayumi, Pfeiffer Michael, Peterson Brandon, Ruzieh Mohammed, Gao Zhaohui, Boehmer John, Gorcsan John, Wilson Ryan
Heart and Vascular Institute, Pennsylvania State University College of Medicine Hershey PA USA.
Division of Cardiovascular Medicine University of Florida College of Medicine Gainesville FL USA.
J Am Heart Assoc. 2025 Apr;14(7):e036294. doi: 10.1161/JAHA.124.036294. Epub 2025 Mar 26.
Right ventricular (RV) dysfunction has been identified as a prognostic marker for adverse events in patients with intermediate-risk pulmonary embolism. We hypothesized that right-sided strain parameters have additive value to conventional echocardiographic parameters to further risk-stratify patients for mortality.
This is a retrospective cohort study of patients with intermediate-risk pulmonary embolism between 2010 and 2018. All-cause 30-day mortality was evaluated. Echocardiographic strain parameters and conventional RV measurements were compared between survivors and nonsurvivors. Two hundred fifty-one patients were analyzed. Mortality at 30 days was 12.4%. Image quality was sufficient for RV strain analysis in 230 patients (91.6%). Right to left ventricular end-diastolic diameter ratio (RV/LV ratio) (odds ratio [OR], 1.490 [95% CI, 1.120-1.990]) and RV global longitudinal strain (RVGLS) (OR, 0.742 [95% CI, 0.605-0.910]) were independently associated with 30-day mortality. Using RVGLS and RV/LV ratio in an additive fashion, we found that 99 patients with a high RVGLS (>17.7%) and low RV/LV ratio (<1.03) had a 30-day mortality of 1.0%. Conversely, 39 patients with a low RVGLS (≤17.7%) and high RV/LV ratio (≥1.03) had a 30-day mortality of 46.2%. Kaplan-Meier analysis depicted the significantly different prognosis among the groups (<0.001).
The combined evaluation of RVGLS and RV/LV ratio is a practical method of evaluating RV dysfunction. Using both parameters in patients with intermediate-risk pulmonary embolism identifies those at highest and lowest risk of short-term mortality. This approach offers promise for improved risk stratification and guidance of treatment pathways.
右心室（RV）功能障碍已被确定为中度风险肺栓塞患者不良事件的预后标志物。我们假设右侧应变参数对传统超声心动图参数具有附加价值，可进一步对患者进行死亡风险分层。
这是一项对2010年至2018年间中度风险肺栓塞患者的回顾性队列研究。评估全因30天死亡率。比较幸存者和非幸存者的超声心动图应变参数和传统右心室测量值。共分析了251例患者。30天死亡率为12.4%。230例患者（91.6%）的图像质量足以进行右心室应变分析。右心室与左心室舒张末期直径比值（RV/LV比值）（比值比[OR]，1.490[95%可信区间，1.120 - 1.990]）和右心室整体纵向应变（RVGLS）（OR，0.742[95%可信区间，0.605 - 0.910]）与30天死亡率独立相关。以相加的方式使用RVGLS和RV/LV比值，我们发现99例右心室整体纵向应变高（>17.7%）且右心室与左心室舒张末期直径比值低（<1.03）的患者30天死亡率为1.0%。相反，39例右心室整体纵向应变低（≤17.7%）且右心室与左心室舒张末期直径比值高（≥1.03）的患者30天死亡率为46.2%。Kaplan - Meier分析显示各组之间预后有显著差异（<0.001）。
联合评估右心室整体纵向应变和右心室与左心室舒张末期直径比值是评估右心室功能障碍的一种实用方法。在中度风险肺栓塞患者中使用这两个参数可识别出短期死亡风险最高和最低的患者。这种方法有望改善风险分层并指导治疗途径。
