Relationship Between the Echocardiographic Simple Right Ventricular Contraction Pressure Index and Hospital Mortality in Patients with Acute Pulmonary Embolism Undergoing Thrombolytic Therapy

Öz

Aim: Acute pulmonary embolism (APE) remains a leading cause of cardiovascular death, with recent trends indicating an upward shift in mortality rates adjusted for age and sex. Risk assessment models for APE currently incorporate a variety of clinical, imaging, and hemodynamic parameters. The right ventricular contraction pressure index (RVCPI), a novel echocardiographic parameter, serves as an emerging tool for evaluating right ventricular (RV) systolic performance. This study explores the association between RVCPI and in-hospital mortality among patients receiving thrombolytic therapy (TT) for APE. Material and Methods: This retrospective study evaluated 75 patients diagnosed with APE who underwent TT. After applying exclusion criteria, 40 eligible patients were included. All patients underwent transthoracic echocardiography prior to treatment, and RVCPI values were computed accordingly. Results: Higher RVCPI values were significantly associated with elevated in-hospital mortality rates (819.8±121.05 vs. 1059.17±206.84, p=0.005). Univariate logistic regression revealed that gender and RVCPI were significantly linked to mortality. Multivariate analysis confirmed that RVCPI independently predicted in-hospital mortality. Receiver operating characteristic (ROC) analysis identified a threshold of RVCPI >800, which demonstrated 100% sensitivity and 64.7% specificity, Conclusion: RVCPI appears to be a reliable, non-invasive indicator for identifying high-risk APE patients undergoing thrombolytic therapy and may enhance early risk stratification.

Anahtar Kelimeler

• pulmonary embolism
• simple right ventricular contraction pressure index
• mortality
• echocardiography

Kaynakça

1. 1. Barco S, Valerio L, Ageno W, Cohen AT, Goldhaber SZ, Hunt BJ, et al. Age-sex specific pulmonary embolism-related mortality in the USA and Canada, 2000–18: an analysis of the WHO Mortality Database and of the CDC Multiple Cause of Death database. Lancet Respir Med. 2021;9:33–42.
2. 2. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): T he Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Heart J. 2019;41:543–603.
3. 3. Chan CM, Woods C, Shorr AF. The validation and reproducibility of the pulmonary embolism severity index. J T hromb Haemost. 2010;8:1509–14.
4. 4. Jiménez D, Aujesky D, Moores L, Gómez V, Lobo JL, Uresandi F, et al. RIETE investigators. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med. 2010;170:1383–89.
5. 5. Aujesky D, Roy PM, Verschuren F, Righini M, Osterwalder J, Egloff M, et al. Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomized, non-inferiority trial. Lancet. 2011;378:41–8.
6. 6. Harjola VP, Mebazaa A, Čelutkienė J, Bettex D, Bueno H, Chioncel O, et al. Contemporary management of acute right ventricular failure: a statement from the heart failure association and the working group on pulmonary circulation and right ventricular function of the European Society of Cardiology. Eur J Heart Fail. 2016;18:226–41.
7. 7. Artac I, Omar T, Karakayali M, Ilis D, Karabag Y, Rencuzogullari I. Assessment of the relationship between C-reactive protein to albumin ratio and late-term mortality in patients with acute pulmonary embolism. Asian Cardiovasc Thorac Ann. 2023;31:332–9.
8. 8. Frea S, Bovolo V, Bergerone S, D’Ascenzo F, Antolini M, Capriolo M, et al. Echocardiographic evaluation of right ventricular stroke work index in advanced heart failure: a new index? J Card Fail. 2012;18:886–93.

9. 9. Vonk Noordegraaf A, Westerhof BE, Westerhof N. The relationship between the right ventricle and its load in pulmonary hypertension. J Am Coll Cardiol. 2017;69(2):236–43.
10. 10. Sintek M, Raymer D, Sparrow C, Nassif M, LaRue S, Vader J. Echo derived right ventricular contraction pressure index predicts right ventricular failure and mortality in patients with durable left ventricular assist devices. J Am Coll Cardiol. 2015;65:894.
11. 11. Bellavia D, Iacovoni A, Scardulla C, Moja L, Pilato M, Kushwaha SS, et al. Prediction of right ventricular failure after ventricular assist device implant: systematic review and meta-analysis of observational studies. Eur J Heart Fail. 2017;19:926–46.
12. 12. LaRue SJ, Raymer DS, Pierce BR, Nassif ME, Sparrow CT, Vader JM. Clinical outcomes associated with INTERMACSdefined right heart failure after left ventricular assist device implantation. J Heart Lung Transplant. 2017;36:475–77.
13. 13. Kalenderoğlu K, Güvenç TS, Mete MT, Kuplay H, Ağustos S, Güzelburç ÖÇ, et al. Usefulness of right ventricular contraction pressure index to predict short-term mortality and right heart failure in patients who underwent continuous-flow left ventricular assist device implantation. Int J Artif Organs. 2020;43:25–36.
14. 14. Acar E, Ozgul N, Izci S. The simple right ventricle contraction pressure index: A novel method for echocardiographic assessment of right ventricle dysfunction in acute pulmonary embolism. J Clin Ultrasound. 2021;49(5):466–71.
15. 15. Ciurzyński M, Kurnicka K, Lichodziejewska B, Kozłowska M, Pływaczewska M, Sobieraj P, et al. Tricuspid regurgitation peak gradient (TRPG) /tricuspid annulus plane systolic excursion (TAPSE) - a novel parameter for stepwise echocardiographic risk stratification in normotensive patients with acute pulmonary embolism. Circ J. 2018;82:1179–85.
16. 16. Armstrong HF, Schulze PC, Kato TS, Bacchetta M, T hirapatarapong W, Bartels MN. Right ventricular stroke work index as a negative predictor of mortality and initial hospital stay after lung transplantation. J Heart Lung Transplant. 2013;32(6):603–8