ECHOCARDIOGRAPHY DOPPLER IN PULMONARY-EMBOLISM - RIGHT-VENTRICULAR DYSFUNCTION AS A PREDICTOR OF MORTALITY-RATE

To test the hypothesis that right ventricular (RV) systolic dysfunctio n at the time of diagnosis of pulmonary embolism (PE) is a predictor o f mortality rate, 126 consecutive patients with PE were examined with echocardiography Doppler (ED) on the day of diagnosis. RV function was assessed by evaluation of wall motion on a four-point scale. The mate rial was divided into two groups: group A (n = 56) with normal or slig htly reduced RV function and group B (n = 70) with moderately or sever ely reduced RV function. The overall mortality rate was 7.9% in the ho spital and 15.1% within 1 year. Four deaths occurred in group A and 15 in group B (p = 0.04). All in-hospital deaths (n = 10) occurred in gr oup B (p = 0.002). The variables associated with mortality rate were R V dysfunction and cancer (in-hospital, p = 0.002 and 0.004; 1 year, p = 0.04 and <0.001, respectively). Nine (7.1%) deaths (all in-hospital) were caused by PE. Five of these patients had advanced-stage cancer, The in-hospital mortality rate in patients without cancer was 4%, all from PE and all in group B. In conclusion, RV dysfunction when diagnos is of PE is established is associated with mortality rate. A strategy for risk stratification of patients with PE with ED may be of clinical usefulness.