What is the clinical evidence from this study?

Study design: Cohort. Population: Intermediate-risk pulmonary embolism (n=251). Intervention: Low right ventricular septal strain (≤14.4%) vs. High right ventricular septal strain (>14.4%). Primary outcome: 30-day all-cause mortality (HR 9.29, 95% CI 4.29-20.7, p=<0.001).

What question did this study set out to answer?

This study aims to evaluate the prognostic value of right ventricular septal strain in predicting 30-day mortality in patients with intermediate-risk pulmonary embolism.

May 16, 2026Open Access

Prognostic Value of Right Ventricular Septal Longitudinal Strain in Intermediate-Risk Pulmonary Embolism

Q: What are the key findings of this study?

Low right ventricular septal strain (≤14.4%) was associated with a significantly higher risk of 30-day mortality compared to high right ventricular septal strain (HR 9.29) in patients with intermediate-risk pulmonary embolism.

Q: What question did this study set out to answer?

This study aims to evaluate the prognostic value of right ventricular septal strain in predicting 30-day mortality in patients with intermediate-risk pulmonary embolism.

AEAyumi EguchiPennsylvania State University SEShunsuke EguchiPennsylvania State University YOYoshiyuki OriharaPennsylvania State University

Key Result

Low right ventricular septal strain (≤14.4%) was associated with a significantly higher risk of 30-day mortality compared to high right ventricular septal strain (HR 9.29) in patients with intermediate-risk pulmonary embolism.

Key Points

This study aims to evaluate the prognostic value of right ventricular septal strain in predicting 30-day mortality in patients with intermediate-risk pulmonary embolism.
Retrospective cohort study of patients with intermediate-risk pulmonary embolism admitted to Penn State Health Milton S. Hershey Medical Center from 2010 to 2018.
Measured right ventricular septal strain within the RV endocardium, defining it as the mean of basal, mid, and apical septal longitudinal strain.
Analyzed data from 251 patients to determine the association between RV septal strain and 30-day mortality.
Among 251 patients, 31 (12.4%) died within 30 days of PE diagnosis.
RV septal strain was significantly lower in those who died (P<0.001) and was independently associated with 30-day mortality.
Kaplan-Meier curves showed that patients with low RV septal strain (≤14.4%) had a higher risk of mortality (hazard ratio 9.29; P<0.001).

Study Design

Type

Cohort (n=251)

Multicenter

Structured PICO

Does right ventricular septal longitudinal strain predict 30-day mortality in patients with intermediate-risk pulmonary embolism?

Population

251 consecutive patients with intermediate-risk pulmonary embolism admitted to a single center between 2010 and 2018.

Intervention

Measurement of right ventricular (RV) septal longitudinal strain (mean of basal, mid, and apical septal longitudinal strain)

Comparator

High (>14.4%) versus low (≤14.4%) RV septal strain

Outcome

30-day all-cause mortalityhard clinical

Right ventricular septal longitudinal strain ≤14.4% is a strong independent predictor of 30-day mortality in patients with intermediate-risk pulmonary embolism.

Main Result

Effect estimate: HR 9.29 (95% CI 4.29-20.7)

p-value: p=<0.001

Limitations

Single-center retrospective cohort study with a relatively small sample size.
Evaluated all-cause mortality at 30 days, so specific causes of death could not be determined.
Residual confounding from unmeasured clinical factors and competing risks cannot be completely excluded.
Cohort was restricted to intermediate-risk PE defined by RV dysfunction, potentially attenuating prognostic performance of conventional RV parameters.
Possibility of center-specific bias in measurements.
Used only one strain analysis software, and inter-vendor variability was not assessed.
Normal reference values for RV septal strain have not yet been established.

Abstract

BACKGROUND: The interventricular septum contributes 30-60% of right ventricular (RV) output. However, few studies have assessed the prognostic value of RV septal strain in pulmonary embolism (PE). We hypothesized that RV septal strain would predict 30-day mortality in patients with intermediate-risk PE. METHODS AND RESULTS: This retrospective cohort study analyzed consecutive patients with intermediate-risk PE admitted to the Penn State Health Milton S. Hershey Medical Center between 2010 and 2018. The primary outcome was 30-day all-cause mortality. RV septal strain was measured within the RV endocardium and was defined as the mean of basal, mid, and apical septal longitudinal strain. Among 251 patients, 31 (12.4%) died within 30 days of PE diagnosis. RV strain analysis was feasible in 230 (91.6%) patients. RV septal strain was significantly lower in those who died and was independently associated with 30-day mortality (P14.4%) RV septal strain (hazard ratio 9.29; P<0.001). CONCLUSIONS: RV septal strain is a feasible and reproducible parameter with strong prognostic value in patients with intermediate-risk PE. These findings highlight the central role of the interventricular septum in RV function and risk stratification.

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