Arterial hypotension at admission as a right ventricle dysfunction marker in patients with pulmonary embolism

Introduction

Arterial hypotension is considered a poor prognostic factor in patients with pulmonary embolism (PE), and has been correlated with right ventricle dysfunction (RVD). In case of haemodynamic instability, thrombolytic treatment is frequently indicated.

Objective

To evaluate the relation between arterial hypotension and RVD in patients with PE.

Patients and method

Data were collected from a cohort of 202 patients (84 men) enrolled in a multicenter prospective registry study of PE. The mean age was 70.9 ± 13.8 years. Patients were admitted to hospitals between January 1998 and January 2001. The diagnosis of PE was confirmed if patients fulfilled at least one of the following criteria: (1) pulmonary artery thrombus visualization by pulmonary arteriography, helicoidal angiotomography, magnetic resonance or echocardiography; (2) high probability pulmonary scintigraphy; and (3) venous duplex scan with thrombus visualization and clinical signs and symptoms of PE. Arterial hypotension was considered if systolic arterial blood pressure was below 90 mmHg, at admission. The transthoracic echocardiogram (TTE) were performed in 193 patients and the RVD was established by subjective analysis of right ventricle function.

Results

Arterial hypotension was present in 40 (21%) and the TTE showed RVD in 73 (38%). Arterial hypotension was detected in 21 (29%) patients in RVD group versus 19 (16%) patients in the group without RVD (P = 0.03). The diagnostic accuracy of arterial hypotension regarding RVD was measured as follows: sensitivity 29% and specificity 84%, with a positive predictive value of 52.5% and negative predictive value of 66%. The likelihood ratio of positive test was 1.82 and the likelihood ratio of negative test was 0.85.

Conclusion

Arterial hypotension is not a good marker of RVD in patients with PE.