Cor Vasa 2023, 65(4):617-623 | DOI: 10.33678/cor.2023.020

Can systolic pulmonary artery pressure be used as one of the criteria of risk stratification in acute pulmonary embolism?

Habibe Hezer^a, Ayse Sule Ates^b, Idris Yakut^c, Hatice Kilic^d, H. Canan Hasanoglu^d

^a Department of Pulmonary Diseases, Ankara City Hospital, Ankara, Turkey

^b Department of Pulmonary Diseases, Sakarya Training and Research Hospital, Sakarya, Turkey

^c Department of Cardiology, Ankara City Hospital, Ankara, Turkey

^d Department of Pulmonary Diseases, Ankara Yildirim Beyazit University, Faculty of Medicine, Ankara, Turkey

Background: In acute pulmonary embolism (PE), rapid diagnosis and treatment planning according to mortality risk classification are important.

Objectives: To explore the effectiveness of systolic pulmonary artery pressure (sPAP) values in the risk stratification of the patients with acute PE.

Methods: This study is a retrospective, cross-sectional clinical trial design. A total of 221 patients who were admitted to our hospital and diagnosed as acute PE by thorax computed tomography pulmonary angiography (CTPA) was included in the study. All patients were evaluated by echocardiography (ECHO) and sPAP was calculated by Bernoulli equation. The relationships between variables such as the European Society of Cardiology (ESC) risk stratification, right ventricular dysfunction (RVD), troponin T, and sPAP levels were examined with Spearman's correlation coefficients.

Results: A strong positive linear correlation was found between sPAP, and troponin T, RVD, ESC high-risk, intermediate-high risk groups (Spearman's r = 0.615, 0.798, 0.411, 0.408, p <0.001, respectively). The optimal cut-off value for sPAP was found as 41.5 mmHg with an overall accuracy of 0.961 (95% CI: 0.937-0.984). Besides, at the cut-off value of 41.5 mmHg, sPAP was found effective in determining RVD and ESC risk groups (p <0.0001). Sensitivity and specificity of sPAP was found as 85%, 92%, respectively in detecting RVD above 41.5 mmHg cut-off value.

Conclusions: Although sPAP is not considered as a reliable finding of ECHO in the patients with acute PE, our study results confirmed that it can be valuable in the risk stratification of acute PE. It would be useful to include sPAP to RVD criteria for acute PE risk stratification.

Keywords: Echocardiography, Pulmonary embolism, Right ventricular dysfunction, Risk stratification, Systolic pulmonary artery pressure

Received: October 2, 2022; Revised: January 30, 2023; Accepted: March 8, 2023; Published: September 1, 2023  Show citation