BACKGROUND There remains uncertainty in the optimal prognostication and management of patients with intermediate-risk PE. Transthoracic echocardiography can identify right ventricular (RV) dysfunction to recognise intermediate-high risk patients. RESEARCH QUESTION The aim of this study was to test whether echocardiography-derived stroke volume index (SVI) is associated with death or cardiopulmonary decompensation in intermediate-risk patients with pulmonary embolism (PE). STUDY DESIGN AND METHODS We retrospectively evaluated echocardiographic-derived variables including SVI in normotensive patients with acute pulmonary embolism admitted between January 2012 and March 2017. SVI was determined using the Doppler velocity-time integral in the left or right ventricular outflow tract. The primary outcome was in-hospital PE-related death or cardiopulmonary decompensation. We used logistic regression to determine the association between SVI and outcomes, and receiver operating characteristic analysis to compare the performance of SVI and other echocardiographic measures. RESULTS The primary outcome occurred in 26 (3.9%) of the 665 intermediate-risk PE patients. Univariate logistic regression showed an odds ratio of 1.37 (95% CI, 1.23-1.52, p<0.001) per 1 mL/m2 decrease in SVI for the primary outcome. Bivariate logistic regression showed that SVI was independent of age, sex, heart rate, VTI and Bova score. SVI had the highest C-statistic of 0.88 (95% CI, 0.81-0.96) of all echocardiographic variables with a Youden's J-statistic identifying an optimal cut-point of 20.0 mL/m2, which corresponds to positive and negative likelihood ratios of 6.5 (95% CI, 5.0-8.6) and 0.2 (95% CI, 0.1-0.5) for the primary outcomes, respectively. INTERPRETATION Low SVI was associated with in-hospital death or cardiopulmonary decompensation in acute PE. SVI had excellent performance compared to other clinical and echocardiographic variables.

中文翻译：

---

超声心动图衍生的每搏输出量指数与中危急性肺栓塞的不良住院结局相关：一项回顾性队列研究

背景 中危 PE 患者的最佳预后和管理仍存在不确定性。经胸超声心动图可以识别右心室 (RV) 功能障碍以识别中高危患者。研究问题 本研究的目的是测试超声心动图衍生的每搏输出量指数 (SVI) 是否与肺栓塞 (PE) 中危患者的死亡或心肺失代偿有关。研究设计和方法 我们回顾性评估了 2012 年 1 月至 2017 年 3 月期间入院的血压正常的急性肺栓塞患者的超声心动图衍生变量，包括 SVI。 SVI 是使用左心室或右心室流出道的多普勒速度-时间积分确定的。主要结局是院内 PE 相关死亡或心肺失代偿。我们使用逻辑回归来确定 SVI 与结果之间的关联，并使用接收者操作特征分析来比较 SVI 和其他超声心动图测量的性能。结果 665 名中危 PE 患者中有 26 名 (3.9%) 出现了主要结局。单变量逻辑回归显示主要结果的 SVI 每减少 1 mL/m2，优势比为 1.37（95% CI，1.23-1.52，p<0.001）。双变量逻辑回归显示 SVI 与年龄、性别、心率、VTI 和 Bova 评分无关。在所有超声心动图变量中，SVI 的 C 统计量最高，为 0.88（95% CI，0.81-0.96），尤登 J 统计量确定了 20.0 mL/m2 的最佳临界点，这对应于主要结果的阳性和阴性似然比分别为 6.5（95% CI，5.0-8.6）和 0.2（95% CI，0.1-0.5）。解释 低 SVI 与急性 PE 的院内死亡或心肺失代偿有关。与其他临床和超声心动图变量相比，SVI 具有出色的性能。