Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction

Background-The role of echocardiographic right ventricular (RV) dysfunction in predicting clinical outcome in clinically stable patients with pulmonar y embolism (PE) is undefined. In this study, we assessed the prevalence and clinical outcome of normotensive patients with RV dysfunction among a broa d spectrum of PE patients. Methods and Results-This prospective clinical outcome study included cohort of 209 consecutive patients (age, 65+/-15 years) with documented PE. Acute RV dysfunction was diagnosed in the presence of greater than or equal to 1 of the following: RV dilatation (without hypertrophy), paradox septal syst olic motion, and Doppler evidence of pulmonary hypertension. Four groups we re identified: 28 patients presenting with shock or cardiac arrest (13%), 1 9 hypotensive patients without shock (9%), 65 normotensive patients with ec hocardiographic RV dysfunction (31%), and 97 normotensive patients without RV dysfunction (47%). Among normotensive patients with RV dysfunction, 6 (1 0%) developed PE-related shock after admission: 3 of these patients died, a nd 3 were successfully treated with thrombolytic agents. In comparison, non e of the 97 normotensive patients without RV dysfunction developed shock or died as a result of PE. Conclusions-A significant proportion (31%) of normotensive patients with ac ute PE presents with RV dysfunction; these patients with latent hemodynamic impairment have a 10% rate of PE-related shock and 5% in-hospital mortalit y and may require aggressive therapeutic strategies. Conversely, normotensi ve patients without echocardiographic RV dysfunction have a benign short-te rm prognosis. Thus, early detection of echocardiographic RV dysfunction is of major importance in the risk stratification of normotensive patients wit h acute PE.