Additive Value of Right Ventricular Global Longitudinal Strain to a Conventional Echocardiographic Parameter to Improve Prognostic Value in Intermediate‐Risk Pulmonary Embolism

Background Right ventricular (RV) dysfunction has been identified as a prognostic marker for adverse events in patients with intermediate‐risk pulmonary embolism. We hypothesized that right‐sided strain parameters have additive value to conventional echocardiographic parameters to further risk‐stratify patients for mortality. Methods and Results This is a retrospective cohort study of patients with intermediate‐risk pulmonary embolism between 2010 and 2018. All‐cause 30‐day mortality was evaluated. Echocardiographic strain parameters and conventional RV measurements were compared between survivors and nonsurvivors. Two hundred fifty‐one patients were analyzed. Mortality at 30 days was 12.4%. Image quality was sufficient for RV strain analysis in 230 patients (91.6%). Right to left ventricular end‐diastolic diameter ratio (RV/LV ratio) (odds ratio [OR], 1.490 [95% CI, 1.120–1.990]) and RV global longitudinal strain (RVGLS) (OR, 0.742 [95% CI, 0.605–0.910]) were independently associated with 30‐day mortality. Using RVGLS and RV/LV ratio in an additive fashion, we found that 99 patients with a high RVGLS (>17.7%) and low RV/LV ratio (<1.03) had a 30‐day mortality of 1.0%. Conversely, 39 patients with a low RVGLS (≤17.7%) and high RV/LV ratio (≥1.03) had a 30‐day mortality of 46.2%. Kaplan–Meier analysis depicted the significantly different prognosis among the groups ( P <0.001). Conclusions The combined evaluation of RVGLS and RV/LV ratio is a practical method of evaluating RV dysfunction. Using both parameters in patients with intermediate‐risk pulmonary embolism identifies those at highest and lowest risk of short‐term mortality. This approach offers promise for improved risk stratification and guidance of treatment pathways.