Abstract
INTRODUCTION: Guidelines of PE recommend that intermediate risk patients should be classified in low and high-intermediate.Patients selected according to current recommendations present no more than 15%complications at 30days when traditional echocardiographic criteria were used.Our Group recently demonstrated that TAPSE added to RV/LV improves prognostic efficacy of classical parameters(p<0.001).
OBJECTIVE: Evaluate RV/LV>1 +TAPSE<16mm instead of traditional criteria to determine capacity to select intermediate-high risk patients.
METHODS: 848 patients diagnosed with stable PE.Severity was evaluated using sPESI.Classical criteria of RVD was determined with 2:dilatation RV,hypokinesis RVorPAP>30mmHg.The criteria we propose includes RV/LV>1+TAPSE<16mm.Complicated clinical course(CCC)considered when death, sustained hypotension,cardiopulmonary arrest,endotracheal intubation or vasoactive support occured.Students t-test,Mann-Whitney Utest and Fisher's test were used.Level of significance set at p<0.05.
RESULTS: 7.4%patients presented CCC.63.1%were classified as intermediate risk(sPESI>0)and 18.3%also had(+)Troponin.Positive predictive value(PPV)for CCC of combination sPESI>0,(+)Troponin and RVD with classical criteria was 18.4%whereas PPV using the proposed criteria was 29.6%.
CONCLUSION: In PE patients with intermediate risk the presence of RVD with the proposed new criteria can identify more efficiently patients with higher risk of CCC.
- Copyright ©the authors 2016
