Early Use of Echocardiography in Patients With Acute Pulmonary Embolism: Findings From the RIETE Registry

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; 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.

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Наслов:	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 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.
Issue Date:	4-сеп-2018
Publisher:	Ovid Technologies (Wolters Kluwer Health)
Journal:	Journal of the American Heart Association
Abstract:	<jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> Transthoracic echocardiography ( <jats:styled-content style="fixed-case">TTE</jats:styled-content> ) is often considered for risk stratification of patients with acute pulmonary embolism ( <jats:styled-content style="fixed-case">PE</jats:styled-content> ). We sought to determine the contemporary utilization of early <jats:styled-content style="fixed-case">TTE</jats:styled-content> (within 72 hours of <jats:styled-content style="fixed-case">PE</jats:styled-content> diagnosis) and explored the association between <jats:styled-content style="fixed-case">TTE</jats:styled-content> findings and <jats:styled-content style="fixed-case">PE</jats:styled-content> ‐related mortality. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> Data from the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry, a multicenter registry of consecutive patients with acute <jats:styled-content style="fixed-case">PE</jats:styled-content> , were used (2001–July 2017). We used a generalized linear mixed model to determine predictors of early <jats:styled-content style="fixed-case">TTE</jats:styled-content> performance. Moreover, the association between 3 <jats:styled-content style="fixed-case">TTE</jats:styled-content> variables (right atrial enlargement, right ventricular hypokinesis, and presence of right heart thrombi) and 30‐day <jats:styled-content style="fixed-case">PE</jats:styled-content> ‐related mortality was assessed in generalized linear mixed models adjusted for <jats:styled-content style="fixed-case">PE</jats:styled-content> severity index, and other comorbidities. Among 35 935 enrollees with acute <jats:styled-content style="fixed-case">PE</jats:styled-content> , 15 375 (42.8%) underwent early <jats:styled-content style="fixed-case">TTE</jats:styled-content> . There was an increase in early <jats:styled-content style="fixed-case">TTE</jats:styled-content> utilization rate over time ( <jats:italic>P</jats:italic> <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 <jats:styled-content style="fixed-case">TTE</jats:styled-content> ( <jats:italic>P</jats:italic> <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 <jats:styled-content style="fixed-case">PE</jats:styled-content> ‐related mortality. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> Early <jats:styled-content style="fixed-case">TTE</jats:styled-content> is commonly performed for acute <jats:styled-content style="fixed-case">PE</jats:styled-content> and utilization rates have increased over time. Right atrial enlargement, right ventricular hypokinesis, and right heart thrombi are predictive of worse outcomes. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Clinical Trial Registration</jats:title> <jats:p xml:lang="en"> <jats:styled-content style="fixed-case">URL</jats:styled-content> : <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.clinicaltrials.gov">http://www.clinicaltrials.gov</jats:ext-link> . Unique identifier: <jats:styled-content style="fixed-case">NCT</jats:styled-content> 02832245. </jats:p> </jats:sec>
URI:	http://hdl.handle.net/20.500.12188/29233
DOI:	10.1161/jaha.118.009042
Appears in Collections:	Faculty of Medicine: Journal Articles