Vol. 7, Issue 2, Part A (2025)

Background: Acute pulmonary embolism (PE) imposes abrupt hemodynamic stress on the right ventricle; however, the prognostic value of specific echocardiographic markers remains unclear. We aimed to determine whether RV parameters assessed within 24 hours of diagnosis predict poor clinical outcomes.
Methods: In this multicenter prospective cohort, 150 hemodynamically stable PE patients underwent transthoracic echocardiography within 24 hours. Parameters including TAPSE, RVFAC, RVOT VTI, RVOT AT, and RV tissue Doppler S′ velocity were recorded. Patients were stratified by PASP/LVSV ratio and followed for a composite endpoint of in‑hospital mortality, cardiac arrest, or thrombolysis, plus 90‑day mortality.
Results: High‑risk patients (PASP/LVSV ≥1.0; n=78) exhibited significantly lower TAPSE (1.52±0.26 vs 1.72±0.28 cm), RVOT VTI (9.7±1.3 vs 12.3±1.7 cm), RVOT AT (59±12 vs 79±15 ms), RVFAC (31±11 vs 45±8.5%), and S′ velocity (9.0±1.5 vs 11.4±2.4 cm/s) (all P<0.001). Composite outcomes occurred more frequently in this group (P<0.05). Multivariate analysis identified RVOT AT (OR 1.022 per ms; p = 0.043) and S′ velocity (OR 1.054 per cm/s; p = 0.038) as independent predictors.
Conclusion: Echocardiographic RVOT acceleration time and tissue Doppler systolic velocity independently predict adverse short‑term outcomes in acute PE. Incorporating these metrics into early risk assessment may improve identification of high‑risk patients and guide timely intervention.