The Effect of Thrombolytic Use and Mechanical Ventilation on Echocardiographic Parameters of Survival after Acute Pulmonary Embolism.

95% CI, 0.32‐0.99), and left ventricular ejection fraction (hazard ratio per 10%, 0.75; 95% CI, 0.60‐0.95) remained significant predictors of lower long-term mortality adjusted by age and gender. Similarly, we obtained the same echocardiographic predictors of ICU and hospital mortality when we added the variable use of thrombolytic therapy to our analyses. 1 A distinct analysis of the subgroup of patients who received thrombolytic was not performed given the limited number of patients that received this therapy. The second concern is whether the predictive ability of IVC collapsibility $50% for ICU and hospital mortality was affected by the use of mechanical ventilation. The use of mechanical ventilation was significantly associated with ICU (odds ratio [OR], 12.0; 95% CI, 4.6‐32.3) and hospital (OR, 11.9; 95% CI, 5.3‐27.0) mortality, when adjusted by Acute Physiology and Chronic Health Evaluation (APACHE) IV and Pulmonary Embolism Severity Index (PESI) scores, respectively. IVCcollapsibility$50%remainedasignificantpredictorofICUmortality(OR,0.26;95%CI,0.08‐0.84)whenadjustedbyAPACHEIVscore and the use of mechanical ventilation. Similarly, IVC collapsibility $50% persisted as a significant predictor of hospital mortality (OR, 0.31; 95% CI, 0.11‐0.88) when adjusted by PESI score and the use of mechanical ventilation. In the subgroup of patients who did not requiremechanicalventilation,IVCcollapsibility$50%remainedasignificant predictor of ICU mortality (OR, 0.09; 95% CI, 0.01‐0.93) when adjusted by APACHE IV score. Likewise, IVC collapsibility $50% remained a significant predictor of hospital mortality (OR, 0.18; 95% CI, 0.03‐0.99) when adjusted by PESI score. Conversely, in the subset of patients who required mechanical ventilation, IVC collapsibility $50% was no longer a significant predictor of ICU (OR, 0.45; 95% CI, 0.10‐2.11) or hospital mortality (OR, 0.45; 95% CI, 0.12‐1.69), when adjusted by APACHE IVor PESI score, respectively. In addition, Sanfilippo et al. asked whether we could identify predictors of right ventricular recovery after acute pulmonary embolism. We believethiswouldbeagreatfollow-upstudyforusorotherinvestigators to perform. Unfortunately, we did not collect data on follow-up echocardiography for this particular study. Furthermore, because it was a retrospective cohort study, data on follow-up echocardiography were verylimited,andfollow-upechocardiography wasnotperformedatestablished intervals. Future prospective investigations in which echocardiograms are obtained at predetermined intervals according to established protocols are needed to answer this important question. In summary, adjusting for the use of thrombolytic therapy did not affect our results. Nevertheless, caution should be taken when applying our results to patients with acute pulmonary emboli who received thrombolytic therapy, given that a small percentage of patients received this treatment in our cohort. IVC collapsibility $50% was a predictor of ICU or hospital mortality only in spontaneously breathing patients with acute pulmonary embolism.