PB0965 - The Use of Transthoracic Echocardiography in Adults Hospitalized with Acute Pulmonary Embolism

Monday, July 11, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

BA

Bita Azad, MSc

Medical Student
Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
Ottawa, Ontario, Canada

Co-Author(s)

KS

Katherine Steckham, MD

Resident Physician, Internal Medicine
Department of Medicine, McMaster University, Hamilton, ON, Canada
Hamilton, Ontario, Canada
TA

Tara Azad

Research Trainee
Ottawa Hospital Research Institute, Ottawa, ON, Canada
Ottawa, Ontario, Canada
CA

Craig Ainsworth, MD FRCPC

Associate Professor, Medicine
Department of Medicine, McMaster University, Hamilton, ON, Canada
Hamilton, Ontario, Canada
LL

Lawrence Lau, MD FRCPC

Cardiology Fellow
University of Ottawa Heart Institute, Ottawa, ON, Canada
Ottawa, Ontario, Canada
Siraj Mithoowani, MD MHPE FRCPC

Assistant Professor
Department of Medicine, McMaster University, Hamilton, ON, Canada
Hamilton, Ontario, Canada
Deborah M. Siegal, MD MSc FRCPC

Tier 2 Canada Research Chair in Anticoagulant Treatment of Cardiovascular Disease Hematologist
The Ottawa Hospital
Ottawa, Ontario, Canada

Background: Right ventricular dysfunction (RVD) predicts adverse outcomes in patients with acute pulmonary embolism (PE). However, the use of inpatient transthoracic echocardiography (TTE) to evaluate RVD is variable and its impact on management and outcomes is uncertain, especially in the presence of other markers of RV strain (RV enlargement on CT, elevated troponin).

Aims: Our aims were to (1) characterize the use of TTE in adults hospitalized with PE, (2) explore the relationship between different markers of RVD, and (3) compare outcomes of patients managed with or without TTE.

Methods: We present preliminary data of a multicentre retrospective cohort study of consecutive adults hospitalized with acute PE at four academic hospitals in Hamilton (2) and Ottawa (2) from 2017-2018.

Results: We identified 489 patients (mean age 65±15 years, 47% male). Most patients had a PE involving segmental or larger vessels (88%). TTE was conducted during hospitalization in 184 patients (38%; 44% Hamilton and 21% Ottawa). A higher proportion of patients with elevated troponin (56% vs. 30% p< 0.001) and RV strain on CT (58% vs. 29% p< 0.001) underwent TTE than those without these findings. TTE was more frequent among patients who required intensive care compared to those who did not (61% vs. 33% p< 0.001). A higher proportion of patients with elevated troponin or RV strain on CT had TTE findings of RV enlargement (50% vs. 21%, p< 0.001; 55% vs. 19% p< 0.001) and reduced RV function (50% vs. 25%, p=0.003; 60% vs. 22% p< 0.001).

Conclusion(s): Hospitalized patients with acute PE frequently undergo TTE but utilization varies across centres. Patients with elevated troponin and RV strain on CT were more likely to have RV enlargement and impaired function on TTE. Clarification on the role of inpatient TTE in this population is required to direct appropriate use.