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Cardiovascular Ultrasound
Published in: Cardiovascular Ultrasound 1/2013

Open Access 01-12-2013 | Research

Right atrial to left atrial area ratio on early echocardiography predicts long-term survival after acute pulmonary embolism

Authors: Vincent Chow, Austin Chin Chwan Ng, Tommy Chung, Liza Thomas, Leonard Kritharides

Published in: Cardiovascular Ultrasound | Issue 1/2013

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Abstract

Background

Current guidelines recommend that transthoracic echocardiography (TTE) should be performed for acute risk stratification following acute pulmonary embolism (PE), but it is unclear whether the initial TTE can predict long-term outcome beyond six months. We sought to assess the potential of the initial right atrial (RA) to left atrial (LA) area ratio (RA/LA ratio) on TTE to predict long-term mortality in survivors of submassive PE.

Methods

A derivation cohort comprised a previously reported group of 35 consecutive patients with acute PE who were intensively studied by serial TTE at 1, 2, 5 days, 2, 6, 12 and 26 weeks and RA/LA ratio related to long-term outcome. The Day 1 RA/LA ratio findings were then further related to long-term outcome in 158 patients followed for 3.6 ± 2.3 years.

Results

In the derivation cohort, total mortality was 28.6% (n = 10) following a mean (±standard deviation) follow-up of 4.3 ± 1.9 years. The RA/LA ratio was highly dynamic, being increased at day 1, but normalised rapidly within 2–5 days of presentation and this was most marked amongst long-term non-survivors. A RA/LA ratio > 1.0 on day 1 was independently associated with a three-fold increase in long-term mortality on Kaplan-Meier analysis. Pooled analysis of 158 patient indicated that age, Charlson Comorbidity Index (CCI), simplified Pulmonary Embolism Severity Score (PESI), troponin T, day 1 RA/LA Ratio and pulmonary arterial systolic pressure (PASP) were univariate predictors of long-term mortality. Multivariate analysis identified Day 1 RA/LA Ratio (HR 1.7 per 10% increase,p = 0.002), CCI (HR 2.2 per 1 unit increase, p = 0.004) and age (HR 1.1, p = 0.03) as the only independent predictors of long-term mortality.

Conclusion

A RA/LA Ratio >1.0 at presentation with acute PE was associated with a three-fold increased risk of long-term mortality. The RA/LA ratio on presentation with an acute PE is a simple, novel predictor of long-term survival.
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Metadata
Title
Right atrial to left atrial area ratio on early echocardiography predicts long-term survival after acute pulmonary embolism
Authors
Vincent Chow
Austin Chin Chwan Ng
Tommy Chung
Liza Thomas
Leonard Kritharides
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Cardiovascular Ultrasound / Issue 1/2013
Electronic ISSN: 1476-7120
DOI
https://doi.org/10.1186/1476-7120-11-17

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