Effect of detection method for right ventricular strain on subsequent interventions for acute pulmonary embolism

RATIONALE Right ventricular strain (RVS) is an important prognostic factor in acute pulmonary embolism (PE). Computed tomography pulmonary angiography (CTPA) or transthoracic echocardiography (TTE) may be used to detect RVS. However, there is no consensus on which modality is best to guide the use of advanced interventions for PE.OBJECTIVES This study examines the association between RVS on CTPA and/or TTE and the use of advanced interventions for PE.METHODS Consecutive patients evaluated by the Pulmonary Embolism Response Team (PERT) at a single institution from 2012 to 2021 who received both CTPA and TTE prior to any advanced interventions were retrospectively included. We defined RVS based on a composite of imaging findings. The primary outcome was use of systemic thrombolysis, catheter-based thrombolysis or thrombectomy, surgical embolectomy, or extracorporeal membrane oxygenation (ECMO) within 7 days.MEASUREMENTS AND MAIN RESULTS Of the 872 patients included in the analysis, 14% received an advanced intervention, 47% were positive for RVS on both CTPA and TTE, 7% were positive on CTPA only, 28% were positive on TTE only, and 18% were negative on both modalities. Patients with RVS on both CTPA and TTE received the highest proportion of advanced interventions (20%, p < 0.002), while the use of advanced intervention was not significantly different between all other imaging groups (p > 0.05).CONCLUSION In patients with acute PE evaluated by a PERT, RVS detected by both CTPA and TTE is associated with increased use of advanced interventions. RVS on CTPA or TTE alone did not increase the use of advanced interventions.