Key result
Systolic RV/LV ratio exceeds diastolic in acute PE, with both linked to 7-day clinical outcomes.
Why the study?
End-diastolic RV/LV ratio is often used for PE risk stratification despite RV systolic failure causing death, prompting confirmation of pre-clinical observations of higher RV/LV ratio in systole than diastole.
Does measuring RV/LV ratio in end-systole compared to end-diastole improve prognostic assessment in patients with acute pulmonary embolism?
Observational (n=606)
Blinded analysis
Does measuring RV/LV ratio in end-systole compared to end-diastole improve prognostic assessment in patients with acute pulmonary embolism?
Although RV/LV ratio is higher in systole than diastole in acute PE, both measurements correlate similarly with clinical outcomes, validating the standard practice of diastolic measurement.
Systolic RV/LV ratio exceeds diastolic values in acute PE; observational data support either timing for risk stratification but leave prospective validation open.
OBJECTIVES: In acute pulmonary embolism (PE), the right ventricle (RV) may dilate compromising left ventricular (LV) size, thereby increasing RV/LV ratio. End-diastolic RV/LV ratio is often used in PE risk stratification, though the cause of death is RV systolic failure. We aimed to confirm our pre-clinical observations of higher RV/LV ratio in systole compared to diastole in human patients with PE. METHODS: We blinded and independently analyzed echocardiograms from 606 patients with PE, evaluated by a Pulmonary Embolism Response Team. We measured RV/LV ratios in end-systole and end-diastole and fractional area change (FAC). Our primary outcome was a composite of 7-day clinical deterioration, treatment escalation or death. Secondary outcomes were 7-day and 30-day all-cause mortality. RESULTS: RV/LV ratio was higher in systole compared to diastole (median 1.010 [.812-1.256] vs. .975 [.843-1.149], p < .0001). RV/LV in systole and diastole were correlated (slope = 1.30 [95% CI 1.25-1.35], p < .0001 vs. slope = 1). RV/LV ratios in both systole and diastole were associated with the primary composite outcome but not with all-cause mortality. CONCLUSION: The RV/LV ratio is higher when measured in systole versus in diastole in patients with acute PE. The two approaches had similar associations with clinical outcomes, that is, it appears reasonable to measure RV/LV ratio in diastole.
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Lyhne et al. (2023) conducted an observational in Acute pulmonary embolism (n=606). RV/LV ratio measurement in systole vs. RV/LV ratio measurement in diastole was evaluated on Composite of 7-day clinical deterioration, treatment escalation or death. In patients with acute pulmonary embolism, the RV/LV ratio was significantly higher in systole than in diastole (median 1.010 vs. 0.975, p<0.0001), and both were associated with 7-day clinical outcomes.
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