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Publications

Journal Article Ahead of print 1 citation

PubMed: 42362047 DOI: 10.1016/j.cjca.2026.06.019

Four-Chamber Myocardial Strain to Predict Mortality in Pulmonary Embolism.

Can J Cardiol

Authors: Laurie Soulat-Dufour, Maharajah Ponnaiah, Sylvie Lang, Isaure Evain, Stephane Ederhy, Marion Chauvet-Droit, Elodie Capderou, Camille Arnaud, Claire Boivineau, Pierre-Antoine Le Bos, Lucas Benoudiba Campanini, Manon Gerard, Stéphane Hatem, Franck Boccara, Ariel Cohen

Affiliations

  • Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France; Unité INSERM UMRS 1166 "Unité de recherche sur les maladies cardiovasculaires, du métabolisme et de la nutrition", Institut Hospitalo-Universitaire, Institut de Cardiométabolisme et Nutrition (ICAN), F-75013, Sorbonne Université, Paris, France.
  • Unité INSERM UMRS 1166 "Unité de recherche sur les maladies cardiovasculaires, du métabolisme et de la nutrition", Institut Hospitalo-Universitaire, Institut de Cardiométabolisme et Nutrition (ICAN), F-75013, Sorbonne Université, Paris, France.
  • Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France.
  • Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France; Sorbonne Université, GRC n°22, C2MV-Complications Cardiovasculaires et Métaboliques chez les patients vivant avec le Virus de l'immunodéficience humaine, Inserm UMR_S 938, Centre de Recherche Saint-Antoine, Institut Hospitalo-Universitaire de Cardiométabolisme et Nutrition, Paris, France.
  • Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France; Unité INSERM UMRS 1166 "Unité de recherche sur les maladies cardiovasculaires, du métabolisme et de la nutrition", Institut Hospitalo-Universitaire, Institut de Cardiométabolisme et Nutrition (ICAN), F-75013, Sorbonne Université, Paris, France.

Abstract

BACKGROUND

Echocardiography in acute pulmonary embolism (PE) primarily focuses on right ventricular (RV) function. The involvement of other heart cavities has been less studied, especially regarding its potential impact on prognosis. This study assessed the additional prognostic value of four-chamber myocardial strain beyond usual risk scores during follow-up.

METHODS

This retrospective cohort study included 488 patients hospitalized for PE.

RESULTS

During a median follow-up of 3.6 years, all-cause death (primary outcome) occurred in 93/488 patients (19.1%). At baseline, increasing PE severity across the four European Society of Cardiology (ESC) risk groups was significantly associated with reductions in left atrial (LA), right atrial (RA), and absolute values of biventricular strains (all P < 0.001, except RA contractile strain, P = 0.052). In multivariable analysis, left ventricular global longitudinal strain (> -19.1%), RV free wall strain (> -19.1%), RA reservoir strain (< 27.5%), RA conduit strain (< 16.0%), LA reservoir strain (< 36.4%), and LA conduit strain (< 16.6%) predicted all-cause death independently from body mass index, ESC risk score, B-type natriuretic peptide, and C-reactive protein. Using receiver-operating characteristic analysis, ESC risk score had the lowest area under the curve to predict all-cause mortality risk while a combined approach including clinical, biological, and echocardiography with strain parameters had the highest predictive value.

CONCLUSIONS

Beyond RV remodelling and dysfunction, patients with acute PE may exhibit alterations in myocardial strain across all four cardiac chambers, which could serve as important predictors of all-cause mortality, in addition to conventional echocardiographic parameters.

MeSH

Mortality, Embolism, Cardiology, Pulmonary Embolism, Echocardiography, Myocardial Strain