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TOPLINE:

Right ventricular global longitudinal strain (RVGLS) and right ventricular outflow tract velocity time integral (RVOT VTI) measurements were associated with mortality in critically ill patients with pulmonary embolism. RVGLS was independently associated with the development of heart failure at 6 months.

METHODOLOGY:

• Researchers conducted a prospective cohort study to explore the relationship of right ventricular echocardiography parameters ─ RVGLS and RVOT VTI ─ with mortality in critically ill patients with pulmonary embolism who were admitted to the intensive care unit (ICU) from January 1999 to December 2023.
• They included 463 patients (mean age, 62.3 years; 41.9% women) with pulmonary embolism and followed them for 6 months.
• They also recruited 60 healthy control individuals (mean age, 58.43; 50% women) to establish normal RVGLS and RVOT VTI values in the study population.
• All participants underwent transthoracic echocardiography, and speckle tracking echocardiography was used to assess RVGLS, strain rate, ventricular longitudinal velocity, displacement, and synchrony.
• The outcomes of interest included mortality in the ICU, mortality at 6 months, and cardiorespiratory failure at the 6-month follow-up.

TAKEAWAY:

• A total of 18.4% of patients died in the ICU, and the total mortality rate at 6 months was 20.7%.
• The mortality in the ICU was associated with the pulmonary embolism severity index score (odds ratio [OR], 1.241), RVGLS (OR, 0.421), RVOT VTI (OR, 0.678), left ventricular outflow tract VTI (OR, 0.782), left atrial reservoir (OR, 0.357), and right atrial pump (OR, 0.632; P < .001 for all).
• Factors associated with the 6-month mortality were the pulmonary embolism severity index score (OR, 1.029), RVGLS (OR, 0.657), RVOT VTI (OR, 0.324), left ventricular outflow tract VTI (OR, 0.814), and right atrial pump (OR, 0.352; P < .001 for all).
• At the 6-month follow-up, the development of heart failure was associated with RVGLS (OR, 0.538), the right ventricular basal diameter (OR, 1.173), the pulmonary flow acceleration time in the RVOT (OR, 0.693), estimated pulmonary artery wedge pressure (OR, 1.437), and the presence of an intracavitary thrombus (OR, 1.223; P < .001 for all).

IN PRACTICE:

“Our work provides evidence for the hypothesis that these variables should be evaluated in PE [pulmonary embolism], especially to assess the management of critically ill patients with PE,” the authors wrote.

SOURCE:

This study was led by Manuel Ruiz-Bailén, MD, PhD, University of Jaén, Jaén, Spain. It was published online on March 28, 2025, in the American Journal of Respiratory and Critical Care Medicine.

LIMITATIONS:

The cohort spanned 23 years, during which changes in diagnostics and therapeutics, including the use of different equipment, must have occurred; therefore, the findings should be interpreted with caution. The echocardiographic measurements did not account for basic clinical data such as mechanical ventilation parameters and other predictors of morbidity and mortality. Moreover, it was not feasible to perform adequate stratification as proposed by the European Society of Cardiology guidelines, particularly because sensitivities and other values had changed over the past 24 years.

DISCLOSURES:

This study was supported by the Department of Health of the regional government of Andalusia in Spain. The authors reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.