Echocardiography Doppler in pulmonary embolism: Right ventricular dysfunction as a predictor of mortality rate☆,☆☆,★
Section snippets
Study design and patient selection
The investigation followed a prospective study design. The inclusion criteria were (1) patients with clinical suspicion of PE referred for diagnostic investigation at our hospital, (2) diagnosis of PE confirmed by perfusion-ventilation scintigraphy (V-Q scan) and/or pulmonary angiography, and (3) transthoracic ED investigation performed on the same day as for the diagnosis of PE. Patients were then observed for 1 year.
During the period from Aug. 26, 1988, to Jan. 30, 1993, 141 consecutive
Results
During the study period 157 patients referred to our hospital were diagnosed as having PE after V-Q scan and/or pulmonary angiography. In 16 of these patients, an ED investigation could not be performed on the same day. The reason for this was that the diagnosis of PE was not made at the preliminary evaluation of the lung scintigraphy in two patients, and in 14 patients resources of ED investigation were not available on the day of referral. Of the 141 patients included, 11 were excluded as a
Discussion
In this study we have identified two variables associated with an increased risk of death after diagnosis of PE: decreased RV systolic function at the time of diagnosis for PE and the occurrence of cancer. During the in-hospital period a markedly depressed RV wall motion was significantly associated with death. No patient with a normal RV function died during this period. The increase in risk for death related to the variable RV dysfunction was calculated to be nearly six times greater, but the
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Supported by grants from the Swedish Heart and Lung Foundation and the Karolinska Institute.
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Reprint requests: Ary Ribeiro, Department of Clinical Physiology, Thoracic Clinics, Karolinska Hospital, Box 110, 171 76 Stockholm, Sweden.
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0002-8703/97/$5.00 + 0 4/1/83533