Abstract 4141427: Refining the risk of all-cause death at mid-term in pulmonary embolism using four-cardiac chambers myocardial strain analysis

Introduction: In acute pulmonary embolism (PE), right ventricular (RV) remodeling and hemodynamic involvement using echocardiography data are associated with in-hospital prognosis. The impact on mid-term outcome of right atrial (RA), RV, left ventricle (LV), and left atrial (LA) involvement using myocardial deformation analysis is poorly evaluated. Hypothesis: We hypothesized that acute PE had a global impact on 4-heart cavities geometry and functions. Aims: We sought to evaluate the prognostic value at mid-term of myocardial strain of the 4-cardiac cavities in patients with acute PE. Methods: We retrospectively analyzed 488 patients hospitalized for acute PE. LV, LA, RA and RV strains were measured using speckle tracking transthoracic echocardiography (TTE) at admission. Primary outcome was mid-term all-cause mortality. Results: During a median follow-up of 3.6 (2.7-4.7) years, all-cause death occurred in 93 patients. At baseline, patients with the highest severity of PE, based on ESC risk score determination, had significantly lower LA (reservoir, conduit, contractile), RA (reservoir, conduit), LV (global, GLS) and RV (free wall) longitudinal strains (Figure 1). The optimal strain thresholds associated with mortality are displayed in Table 1: -19.1% for LV and RV, +36.4% for LA reservoir strain, +16.6% for LA conduit strain, +27.5% for RA reservoir strain, +16.0% for RA conduit strain. Kaplan Meier curves for cumulative hazards for all-cause death using strain parameters showed significant difference of survival according to LV GLS, RV free wall strain, LA and RA reservoir strains, LA and RA conduit strains (Figure 2). Conclusion: Beyond RV cavity remodeling and dysfunction, PE induces acute alteration of the 4-cardiac chambers strains. Strain analysis appears as an interesting tool in addition to conventional echocardiographic parameters to assess heart cavities dysfunction and predict mid-term outcome.