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

Abstract

<jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> Transthoracic echocardiography ( <jats:styled-content style="fixed-case">TTE</jats:styled-content> ) is often considered for risk stratification of patients with acute pulmonary embolism ( <jats:styled-content style="fixed-case">PE</jats:styled-content> ). We sought to determine the contemporary utilization of early <jats:styled-content style="fixed-case">TTE</jats:styled-content> (within 72 hours of <jats:styled-content style="fixed-case">PE</jats:styled-content> diagnosis) and explored the association between <jats:styled-content style="fixed-case">TTE</jats:styled-content> findings and <jats:styled-content style="fixed-case">PE</jats:styled-content> ‐related mortality. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> Data from the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry, a multicenter registry of consecutive patients with acute <jats:styled-content style="fixed-case">PE</jats:styled-content> , were used (2001–July 2017). We used a generalized linear mixed model to determine predictors of early <jats:styled-content style="fixed-case">TTE</jats:styled-content> performance. Moreover, the association between 3 <jats:styled-content style="fixed-case">TTE</jats:styled-content> variables (right atrial enlargement, right ventricular hypokinesis, and presence of right heart thrombi) and 30‐day <jats:styled-content style="fixed-case">PE</jats:styled-content> ‐related mortality was assessed in generalized linear mixed models adjusted for <jats:styled-content style="fixed-case">PE</jats:styled-content> severity index, and other comorbidities. Among 35 935 enrollees with acute <jats:styled-content style="fixed-case">PE</jats:styled-content> , 15 375 (42.8%) underwent early <jats:styled-content style="fixed-case">TTE</jats:styled-content> . There was an increase in early <jats:styled-content style="fixed-case">TTE</jats:styled-content> utilization rate over time ( <jats:italic>P</jats:italic> <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 <jats:styled-content style="fixed-case">TTE</jats:styled-content> ( <jats:italic>P</jats:italic> <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 <jats:styled-content style="fixed-case">PE</jats:styled-content> ‐related mortality. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> Early <jats:styled-content style="fixed-case">TTE</jats:styled-content> is commonly performed for acute <jats:styled-content style="fixed-case">PE</jats:styled-content> and utilization rates have increased over time. Right atrial enlargement, right ventricular hypokinesis, and right heart thrombi are predictive of worse outcomes. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Clinical Trial Registration</jats:title> <jats:p xml:lang="en"> <jats:styled-content style="fixed-case">URL</jats:styled-content> : <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.clinicaltrials.gov">http://www.clinicaltrials.gov</jats:ext-link> . Unique identifier: <jats:styled-content style="fixed-case">NCT</jats:styled-content> 02832245. </jats:p> </jats:sec>