Echocardiography does not predict mortality in hemodynamically stable elderly patients with acute pulmonary embolism

• In the elderly stable patient with acute PE the prevalence of RV dysfunction on TTE varies based on the definition used.
• No association between right ventricular dysfunction and short-term clinical outcomes.
• TTE as a stand-alone risk stratification tool in the elderly with acute PE is not recommended.

BackgroundThe evidence on the prognostic value of transthoracic echocardiography (TTE) in elderly, hemodynamically stable patients with Pulmonary Embolism (PE) is limited.ObjectivesTo evaluate the prevalence of common echocardiographic signs of right ventricular (RV) dysfunction and their prognostic impact in hemodynamically stable patients aged ≥ 65 years with acute PE in a prospective multicenter cohort.MethodsTTE was performed by cardiologists. We defined RV dysfunction as a RV/left ventricular ratio > 0.9 or RV hypokinesis (primary definition) or the presence of ≥ 1 or ≥ 2 of 6 predefined echocardiographic signs (secondary definitions). Outcomes were overall mortality and mortality/non-fatal recurrent venous thromboembolism (VTE) at 30 days, adjusting for the Pulmonary Embolism Severity Index risk score and highly sensitive troponin T values.ResultsOf 400 patients, 36% had RV dysfunction based on our primary definition, and 81% (≥ 1 sign) and 53% (≥ 2 signs) based on our secondary definitions, respectively. Using our primary definition, there was no association between RV dysfunction and mortality (adjusted HR 0.90, 95% CI 0.31–2.58) and mortality/non-fatal VTE (adjusted HR 1.09, 95% CI 0.40–2.98). Similarly, there was no statistically significant association between the presence of ≥ 1 or ≥ 2 echocardiographic signs (secondary definitions) and clinical outcomes.ConclusionThe prevalence of echocardiographic RV dysfunction varied widely depending upon the definition used. There was no association between RV dysfunction and clinical outcomes. Thus, TTE may not be suitable as a stand-alone risk assessment tool in elderly patients with acute PE.Clinical trial registrationhttp://clinicaltrials.gov. Identifier: NCT00973596.