Echocardiographic right ventricular metrics and clinical outcomes in acute PE: Insights from a prospective cohort

Abstract

Background: Acute pulmonary embolism (PE) imposes abrupt hemodynamic stress on the right ventricle; however, the prognostic value of specific echocardiographic markers remains unclear. We aimed to determine whether RV parameters assessed within 24 hours of diagnosis predict poor clinical outcomes. Methods: In this multicenter prospective cohort, 150 hemodynamically stable PE patients underwent transthoracic echocardiography within 24 hours. Parameters including TAPSE, RVFAC, RVOT VTI, RVOT AT, and RV tissue Doppler S′ velocity were recorded. Patients were stratified by PASP/LVSV ratio and followed for a composite endpoint of in‑hospital mortality, cardiac arrest, or thrombolysis, plus 90‑day mortality. Results: High‑risk patients (PASP/LVSV ≥1.0; n=78) exhibited significantly lower TAPSE (1.52±0.26 vs 1.72±0.28 cm), RVOT VTI (9.7±1.3 vs 12.3±1.7 cm), RVOT AT (59±12 vs 79±15 ms), RVFAC (31±11 vs 45±8.5%), and S′ velocity (9.0±1.5 vs 11.4±2.4 cm/s) (all P