New echocardiographic predictors of the fatal outcome of pulmonary embolism

The need to develop new more accurate prognostic non-invasive criteria for the severity and outcome of pulmonary embolism. Aims: To establish the prognostic significance in the onset of death in patients with pulmonary embolism for the calculated pressure in the pulmonary artery, the pressure gradient and the work of the right ventricle on the pulmonary artery valve. Materials and methods: The study included 428 patients with pulmonary embolism. 42, despite the treatment, died. The remaining 386 patients were discharged from the hospital with improvement. 244 of them had pulmonary embolism with signs of overload of the right heart during echocardiography, and 142 patients had neither clinical nor instrumental manifestations. Analysis of the prevalence and significance of the developed calculated prognostic criteria among patients of these groups was carried out. Results: It was found that the lower the pressure gradient on the pulmonary artery valve, the more pronounced the disease is, since the volume of blood ejected into the pulmonary trunk decreases. In patients with fatal outcome, this indicator did not exceed 10 mm Hg, and in patients with asymptomatic pulmonary embolism was more than 20 mm Hg. Reference values of the design pressure in the pulmonary artery were determined - from 0 to 12 mm Hg. An increase in this indicator correlated with the appearance of symptoms of the disease, and at values of more than 45 mm Hg, it was associated with a fatal outcome. The work of the right ventricle on the pulmonary artery valve in the asymptomatic course of the disease ranged from 0,2 J to 0,3 J, and with its decrease less than 0,05 J, a fatal outcome was noted in 100% of patients. Conclusions: The developed calculated prognostic criteria informatively and clearly reflect the course of the disease and the likelihood of a fatal outcome.