A28-05 Pre-existing Right Ventricular Abnormalities in Patients Presenting With Acute Pulmonary Embolism: Insights From a Multi-center Cohort Study

Abstract Rationale Pulmonary embolism (PE) is a common and potentially life-threatening condition with a wide spectrum of clinical presentations. Defining the hemodynamic impact of PE is important in the initial evaluation. Transthoracic echocardiography (TTE) plays a central role in PE risk stratification by assessing RV strain - RV dilation or hypokinesis. Hemodynamically stable patients with right ventricular (RV) strain have significantly increased risk of hemodynamic decompensation and mortality compared to patients without RV strain. Yet, it is often difficult to know whether RV strain seen on echocardiogram represents a new finding, associated with PE, or is chronic. The goal of this study was to determine the prevalence of chronic RV strain on baseline TTE among patients diagnosed with acute PE. Methods We conducted a retrospective cohort study of adults evaluated for PE in the emergency departments of seven acute-care hospitals within the Mass General Brigham system. PE+ cases were confirmed by chest CT angiogram reports. We identified those with baseline transthoracic echocardiograms (TTEs), defined as the most recent TTE obtained before PE evaluation, without restriction on interval. A single physician with critical care echocardiography expertise reviewed reports to identify right ventricular (RV) strain, defined by any of the following: basal RV end-diastolic diameter (EDD) 42 mm; mid-cavitary EDD 35 mm; RV/LV ratio 1; tricuspid annular plane systolic excursion (TAPSE) 16 mm; RV fractional area change 35%; S′ 10 cm/s; septal flattening; or McConnell sign. Data were abstracted into a HIPAA-compliant REDCap database. Descriptive statistical analyses were perfomed using Microsoft Excel. Results Among 12,544 unique PE-positive patient encounters, 5,485 patients had a baseline TTE. More than half of patients with a prior TTE(n = 3,027, 55.2%) had the study within one year of PE presentation. 816 (14.9%) had evidence of RV strain on baseline TTE. The median time between the baseline TTE and PE presentation was 279 days (IQR 62-973, range 1-7,365 days). Conclusions Pre-existing RV strain is common in patients presenting with acute PE. Available baseline TTE were often performed within 1 year of PE presentation. These results raise important questions regarding risk stratification, as patients with chronic RV strain may be classified as intermediate-risk despite having chronic RV strain, and possibly no echocardiographic changes. Ongoing investigation evaluating clinical outcomes in this population is needed to determine whether chronic RV strain confers protection against—or predisposes to—hemodynamic decompensation during acute PE. This abstract is funded by: None