Key result
Lower baseline TAPSE by ~5 mm is linked to mortality or clinical deterioration in acute PE.
Why the study?
The prognostic utility of echocardiography in low-to-intermediate risk acute pulmonary embolism remains underexplored, and electrocardiographic findings are infrequently assessed alongside echocardiography for risk stratification.
Do baseline echocardiographic markers of right ventricular function and pulmonary pressure, integrated with electrocardiographic findings, predict in-hospital mortality or clinical deterioration in adults with low-to-intermediate risk acute pulmonary embolism?
Meta-Analysis (n=3,073)
Yes
Do baseline echocardiographic markers of right ventricular function and pulmonary pressure, integrated with electrocardiographic findings, predict in-hospital mortality or clinical deterioration in adults with low-to-intermediate risk acute pulmonary embolism?
Baseline echocardiographic markers of RV systolic dysfunction (TAPSE, RV FAC) and elevated pulmonary pressure (PASP, TRV), supported by ECG findings (T-wave inversion, ischemic ST changes), predict clinical deterioration and mortality in hemodynamically stable low-to-intermediate risk acute pulmonary embolism.
Background: Acute pulmonary embolism (APE) is a cardiovascular emergency with considerable morbidity and mortality. Echocardiography has been an essential tool for risk stratification in high-risk patients. However, its prognostic utility in low-to-intermediate risk cases remains underexplored. Electrocardiographic (ECG) findings may provide additional prognostic information but are infrequently assessed alongside echocardiography. Objective: To assess the prognostic value of baseline echocardiographic parameters in low-to-intermediate risk APE and to examine ECG findings as complementary tools in risk stratification. Methods: A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Literature searches were performed in Medline, Scopus, Google Scholar, and Semantics up to December 2024. Studies enrolling adult patients with confirmed APE categorized as low-to-intermediate risk classification were included. Primary outcomes were in-hospital mortality or clinical deterioration. Pooled estimates were analysed using fixed-or random-effects models, or analysis of P values. Results: Thirteen studies ( n = 3073) were included. Echocardiographic parameters significantly associated with adverse outcomes included reduced tricuspid annular plane systolic excursion, RV fractional area change, and elevated pulmonary artery systolic pressure and tricuspid regurgitation velocity. ECG findings of T wave inversion and ischemic ST changes are strongly correlated with RV dysfunction and increased pulmonary pressures, supporting their adjunctive prognostic value. Conclusion: In low-to-intermediate risk APE, echocardiographic indicators of RV dysfunction and pulmonary pressure are predictive of adverse outcomes. ECG findings were correlated with echocardiographic abnormalities and may enhance risk stratification, especially in resource-limited settings.
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Kusumowardani et al. (2025) conducted a meta-analysis in Low-to-intermediate risk acute pulmonary embolism (n=3,073). Baseline echocardiographic parameters (TAPSE, RV FAC, PASP, TRV) and electrocardiographic findings vs. Patients without adverse outcomes (endpoint negative) or without abnormal echocardiographic/ECG findings was evaluated on Difference in baseline tricuspid annular plane systolic excursion (TAPSE) between patients with vs. without all-cause mortality or clinical deterioration (MD -4.82 mm, 95% CI -6.55 to -3.08, p=<0.00001). Lower baseline TAPSE (MD -4.82 mm, p<0.00001), lower RV FAC (MD -10.86, p<0.00001), and higher PASP (MD 10.79 mmHg, p<0.0001) predicted mortality or clinical deterioration in low-to-intermediate risk APE.
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