Early Use of Echocardiography in Patients With Acute Pulmonary Embolism: Findings From the RIETE Registry
Authors: Bikdeli Behnood , Lobo José Luis , Jiménez David , Green Philip , Fernández‐Capitán Carmen , Bura‐Riviere Alessandra , Otero Remedios , DiTullio Marco R. , Galindo Silvia , Ellis Martin , Parikh Sahil A. , Monreal Manuel ,   the RIETE Investigators, Prandoni Paolo , Brenner Benjamin , Farge‐Bancel Dominique , Barba Raquel , Di Micco Pierpaolo , Bertoletti Laurent , Tzoran Inna , Reis Abilio , Bounameaux Henri , Malý Radovan , Verhamme Peter , Bosevski Marijan , Caprini Joseph A. , Bui Hanh My , Adarraga M.D. , Aibar M.A. , Aibar J. , Alfonso M. , Amado C. , Aranda C. , Arcelus J.I. , Asin U. , Azcarate‐Agüero P.M. , Ballaz A. , Barrón M. , Barrón‐Andrés B. , Bascuñana J. , Blanco‐Molina A. , Camon A.M. , Carrasco C. , Castejón‐Pina N. , Cruz A.J. , de Ancos C. , del Toro J. , Díaz‐Pedroche M.C. , Díaz‐Peromingo J.A. , Falgá C. , Farfán A.I. , Fidalgo M.A. , Font C. , Font L. , Furest I. , García M.A. , García‐Bragado F. , García‐Morillo M. , Gavín O. , Gil A. , Gómez V. , González‐Martínez J. , Grau E. , Guijarro R. , Guirado L. , Gutiérrez J. , Hernández‐Blasco L. , Iglesias C. , Jara‐Palomares L. , Jaras M.J. , Jiménez R. , Jou I. , Joya M.D. , Lima J. , López‐Jiménez L. , López‐Miguel P. , López‐Nuñez J.J. , López‐Reyes R. , López‐Sáez J.B. , Lorente M.A. , Lorenzo A. , Loring M. , Loscos S. , Lumbierres M. , Marchena P.J. , Martínez‐Baquerizo C. , Martín‐Asenjo M. , Martín‐Fernández M. , Martín‐Guerra J.M. , Morales M.V. , Nieto J.A. , Núñez M.J. , Olivares M.C. , Otalora S. , Pedrajas J.M. , Pellejero G. , Pérez‐Ductor C. , Peris M.L. , Pesce M.L. , Porras J.A. , Riesco D. , Rivas A. , Rodríguez‐Dávila M.A. , Rodríguez‐Galán I. , Rodríguez‐Hernández A. , Rosa V. , Rubio C.M. , Ruiz‐Artacho P. , Ruiz‐Ruiz J. , Sahuquillo J.C. , Sala‐Sainz M.C. , Sampériz A. , Sánchez‐Muñoz‐Torrero J.F. , Sancho T. , Sanoja I.D. , Soler S. , Soto M.J. , Suriñach J.M. , Torres M.I. , Trujillo‐Santos J. , Uresandi F. , Usandizaga E. , Valle R. , Vela J. , Vilar C. , Villalobos A. , Vázquez F.J. , Vilaseca A. , Vandenbriele C. , Hij A. , Merah A. , Mahé I. , Moustafa F. , Ellis M. , Bortoluzzi C. , Brandolin B. , Bucherini E. , Ciammaichella M. , Dentali F. , Grandone E. , Imbalzano E. , Lessiani G. , Maida R. , Mastroiacovo D. , Ngoc V. , Pace F. , Parisi R. , Pesavento R. , Pinelli M. , Quintavalla R. , Rocci A. , Romualdi R. , Siniscalchi C. , Sotgiu P. , Tiraferri E. , Tufano A. , Visonà A. , Zalunardo B. , Skride A. , Vitola B. , Zdraveska M. , Mazzolai L. 
Published: September 2018

Background

Transthoracic echocardiography (
TTE
) is often considered for risk stratification of patients with acute pulmonary embolism (
PE
). We sought to determine the contemporary utilization of early
TTE
(within 72 hours of
PE
diagnosis) and explored the association between
TTE
findings and
PE
‐related mortality.

Methods and Results

Data from the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry, a multicenter registry of consecutive patients with acute
PE
, were used (2001–July 2017). We used a generalized linear mixed model to determine predictors of early
TTE
performance. Moreover, the association between 3
TTE
variables (right atrial enlargement, right ventricular hypokinesis, and presence of right heart thrombi) and 30‐day
PE
‐related mortality was assessed in generalized linear mixed models adjusted for
PE
severity index, and other comorbidities. Among 35 935 enrollees with acute
PE
, 15 375 (42.8%) underwent early
TTE
. There was an increase in early
TTE
utilization rate over time (
P
<0.001 for trend). Younger age, female sex, enrollment in countries other than Spain, history of coronary disease, heart failure, atrial fibrillation, tachycardia, and hypotension were the main predictors of early
TTE
(
P
<0.01 for all). In multivariable analyses, right atrial enlargement (adjusted odds ratio: 3.74; 95% confidence interval, 2.10–6.66), right ventricular hypokinesis (adjusted odds ratio: 3.11, 95% confidence interval: 1.85–5.21) and right heart thrombi (adjusted odds ratio: 4.39, 95% confidence interval, 1.99–9.71) were associated with increased odds for
PE
‐related mortality.

Conclusions

Early
TTE
is commonly performed for acute
PE
and utilization rates have increased over time. Right atrial enlargement, right ventricular hypokinesis, and right heart thrombi are predictive of worse outcomes.

Clinical Trial Registration

URL
:
http://www.clinicaltrials.gov
. Unique identifier:
NCT
02832245.