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Early Use of Echocardiography in Patients With Acute Pulmonary Embolism: Findings From the RIETE Registry

2018; Wiley; Volume: 7; Issue: 17 Linguagem: Inglês

10.1161/jaha.118.009042

2047-9980

Behnood Bikdeli, J.L. Lobo, David Jiménez, Philip Green, Carmen Fernández‐Capitán, A. Bura-Rivière, Remedios Otero, Marco R. DiTullio, Silvia Galindo, Martin Ellis, Sahil A. Parikh, Manuel Monréal, Paolo Prandoni, Benjamin Brenner, Dominique Farge, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Inna Tzoran, Abílio Reis, Henri Bounameaux, Radován Malý, Peter Verhamme, Marijan Bosevski, Joseph A. Caprini, My Bui, M.D. Adarraga, Miguel Ángel Aibar Arregui, Jesús Aibar, Michael Alfonso, Cristina Amado, C. Monserrat, J.I. Arcelus, Uxua Asín, Pedro María Azcárate-Agüero, Aitor Ballaz, M. Barrón, B. Barrón‐Andrés, J. Bascuñana, Á. Blanco-Molina, A.M. Camón, C. Carrasco, N. Castejón‐Pina, A.J. Cruz, Cristina de Ancos, J. del Toro, Carmen Díaz‐Pedroche, J.A. Díaz‐Peromingo, C. Falgá, A.I. Farfán, M.A. Fidalgo, Carme Font, Llorenç Font, I. Furest, Marian García-Núñez, F. García‐Bragado, Marcial García-Morillo, O. Gavín, Alfredo Gil, Vicente Gómez del Olmo, J. González‐Martínez, E Grau, Ricardo Guijarro, L. Guirado, Juan Mata, Luis Blasco, Clara Iglesias, Luis Jara‐Palomares, M.J. Jaras, Ruth Jiménez Castuera, I. Jou, M.D. Joya, J. Lima, Luciano López‐Jiménez, Patricia López-Miguel, Juan J. López-Núñez, Raquel López-Reyes, J.B. López‐Sáez, M.A. Lorente, A. Lorenzo, Mónica Loring, S. Loscos, M. Lumbierres, P.J. Marchena, C. Martínez‐Baquerizo, Miguel Martín Asenjo, Miguel Martín-Fernández, J.M. Martín‐Guerra, M.V. Morales, J.A. Nieto, Manuel Jesús Núñez, M.C. Olivares, S. Otálora, José María Pedrajas, G. Pellejero, C. Pérez‐Ductor, M.L. Peris, M.L. Pesce, José Antonio Porras, David Riesco, A. Rivas, M.A. Rodríguez‐Dávila, Irene Rodríguez-Galán, A. Rodríguez‐Hernández, V. Rosa, Carmen Ma. Rubio, Pedro Ruiz‐Artacho, Justo Ruiz-Ruiz, Joan Carles Sahuquillo, M.C. Sala‐Sainz, A. Sampériz, J.F. Sánchez‐Muñoz‐Torrero, Teresa Sancho, I.D. Sanoja, S. Soler, María José Monteagudo Soto, J.M. Suriñach, Marı́a Isabel Torres, Javier Trujillo‐Santos, Fernando Uresandi, Esther Usandizaga, R. Valle, J. Vela, Carlos Vilar, A. Villalobos, Fernando Javier Vázquez, Alicia Vilaseca, Christophe Vandenbriele, A. Hij, A. Merah, I. Mahé, Farès Moustafa, Martin Ellis, Cristiano Bortoluzzi, B. Brandolin, Eugenio Bucherini, Maurizio Ciammaichella, Francesco Dentali, Elvira Grandone, Egidio Imbalzano, Gianfranco Lessiani, R. Maida, Daniela Mastroiacovo, Võ Trương Như Ngọc, F. Pace, Roberto Parisi, Raffaele Pesavento, Massimiliano Pinelli, Roberto Quintavalla, Anna Rocci, Roberta Romualdi, Carmine Siniscalchi, P. Sotgiu, Eros Tiraferri, Antonella Tufano, A. Visonà, Beniamino Zalunardo, Andris Skride, Barbara Vītola, Marija Zdraveska, Lucia Mazzolai,

Acute Myocardial Infarction Research

Background Transthoracic echocardiography ( TTE ) is often considered for risk stratification of patients with acute pulmonary embolism ( PE ). We sought to determine the contemporary utilization of early TTE (within 72 hours of PE diagnosis) and explored the association between TTE findings and PE ‐related mortality. Methods and Results Data from the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry, a multicenter registry of consecutive patients with acute PE , were used (2001–July 2017). We used a generalized linear mixed model to determine predictors of early TTE performance. Moreover, the association between 3 TTE variables (right atrial enlargement, right ventricular hypokinesis, and presence of right heart thrombi) and 30‐day PE ‐related mortality was assessed in generalized linear mixed models adjusted for PE severity index, and other comorbidities. Among 35 935 enrollees with acute PE , 15 375 (42.8%) underwent early TTE . There was an increase in early TTE utilization rate over time ( P <0.001 for trend). Younger age, female sex, enrollment in countries other than Spain, history of coronary disease, heart failure, atrial fibrillation, tachycardia, and hypotension were the main predictors of early TTE ( P <0.01 for all). In multivariable analyses, right atrial enlargement (adjusted odds ratio: 3.74; 95% confidence interval, 2.10–6.66), right ventricular hypokinesis (adjusted odds ratio: 3.11, 95% confidence interval: 1.85–5.21) and right heart thrombi (adjusted odds ratio: 4.39, 95% confidence interval, 1.99–9.71) were associated with increased odds for PE ‐related mortality. Conclusions Early TTE is commonly performed for acute PE and utilization rates have increased over time. Right atrial enlargement, right ventricular hypokinesis, and right heart thrombi are predictive of worse outcomes. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 02832245.