PROGNOSTIC-SIGNIFICANCE OF RIGHT-VENTRICULAR AFTERLOAD STRESS DETECTED BY ECHOCARDIOGRAPHY IN PATIENTS WITH CLINICALLY SUSPECTED PULMONARY-EMBOLISM

Objective-To investigate the prognostic value of echocardiographic fin dings in patients who present with symptoms suggestive of acute pulmon ary embolism. Design-317 patients with clinically suspected pulmonary embolism were prospectively evaluated by echocardiography for the pres ence of right ventricular afterload stress and right heart or pulmonar y artery thrombi. Objective confirmation of pulmonary embolism by lung scan or pulmonary angiography was obtained in 164 (52%). The presence of deep venous thrombosis was established in 90 of 158 patients (57%) who underwent phlebographic or Doppler sonographic studies. Results-R ight ventricular afterload stress was diagnosed in 87 patients (27%). Objective confirmation of pulmonary embolism and diagnosis of deep ven ous thrombosis was more common in patients with right ventricular afte rload stress than in those without (83% v 40% and 16% v 22%, respectiv ely; P < 0.001). This was also true for the detection of thrombi in th e right heart and major pulmonary arteries (12 patients v 1 patient; P < 0.001) as well as for the in-hospital mortality from venous thrombo embolism (13% v 0.9%; P < 0.001). One year mortality from pulmonary em bolism was 13% in patients with right ventricular afterload stress at presentation compared with 1.3% in those without (P < 0.001). Conclusi ons-The presence of right ventricular afterload stress detected by ech ocardiography is a major determinant of short term prognosis in patien ts with clinically suspected acute pulmonary embolism.