Abstract 4371170: Diagnostic Evaluation of Pulmonary Embolism Prior to Pulmonary Embolism Response Teams Implementation: A Retrospective Single-Center Study

Abstract

Introduction: Pulmonary embolism (PE) is the third most common cardiovascular disease.Acute right ventricular (RV) failure due to pressure overload is the leading cause of death in severe PE.Transthoracic echocardiography (TTE) plays a critical role in assessing RV strain when computed tomography pulmonary angiography (CTPA) is not feasible.Markers like tricuspid annular plane systolic excursion (TAPSE),RV systolic pressure (RVSP),and RV strain patterns(e.g. McConnell’s sign, “D”sign)provide prognostic information.Pulmonary Embolism Response Team(PERT) have been shown to streamline PE care and improve outcomes.This study evaluated diagnostic practices related to PE prior to PERT implementation, with emphasis on echocardiographic and radiologic assessment. Methods: We conducted a retrospective review of 1,200 patients diagnosed with PE at a single center where 300 had TTE. After applying exclusion criteria—including incomplete echocardiograms, CTPA/TTE performed after 24 hours, and confounding conditions like sepsis, pneumonia, acute respiratory distress syndrome (ARDS),pleural effusion—41 patients were included.De-identified data were collected on demographics,comorbidities,laboratory results(troponin I,B-type natriuretic peptide[BNP],D-dimer, lactate),echocardiographic parameters(TAPSE, RVSP, RV outflow tract velocity-time integral [RVOT VTI],midsystolic notch,TAPSE/RVSP ratio,RV strain signs),and CTPA findings(RV to left ventricular [RV/LV] ratio, hepatic vein reflux). These were analyzed in comparison with European Respiratory Society and American Thoracic Society guideline benchmarks. Results: Among the 41 included patients, key echocardiographic markers were inconsistently utilized.TAPSE and RVSP were documented in 86% of cases.TAPSE/RVSP ratio-indicative of RV-pulmonary artery (PA) coupling and predictive of mortality was rarely calculated. RVOT VTI and midsystolic notching were infrequently assessed (<10%).Signs of RV strain were inconsistently reported.Despite frequent elevation of troponin and BNP, integrated risk stratification was uncommon.Radiologic findings such as RV/LV ratio and hepatic vein contrast reflux were inconsistently documented. Conclusion: Prior to PERT implementation,significant variability existed in the diagnostic evaluation of acute PE,particularly in the use of echocardiographic and radiologic markers.These findings underscore the potential of PERT to promote standardization,guideline adherence,and early recognition of high-risk PE.