OC 72.3 - Diagnostic Accuracy of Echocardiogram in Pediatric Pulmonary Embolism Severity

Background: Right ventricular dysfunction (RVD) is an established determinant of early hemodynamic decompensation and risk of death in pulmonary embolism (PE). There is no accepted definition of RVD in pediatric PE, but various qualitative or quantitative echocardiographic parameters signify prognostic value in adults with PE.

Aims: We aimed to assess the diagnostic test characteristics of echocardiographic criteria of RVD and establish their diagnostic value for troponin elevation and reperfusion therapies.

Methods: In 120 pediatric patients with acute PE, we blindly assessed transthoracic echocardiograms for pre-specified qualitative and quantitative RVD criteria. We a priori planned a subgroup analysis of all patients with elevated troponin and those who received reperfusion therapies. We determined the diagnostic test characteristics of echo components in the entire patient population and predefined subgroups.

Results: The median age was 16 (IQR:14-17 ); 61% were females. RV dilation, RV free wall hypokinesis, and interventricular septal flattening were found in 17.5%, 7.5%, and 15 % of patients, respectively. Median RV/LV ratio was 0.9 (IQR: 0.6-1); 32% had RV/LV ratio of ≥0.9. Tricuspid regurgitation peak systolic gradient > 30 mmHg and pulmonary ejection acceleration time < 80 msec were measured in 8.3 % and 10.8%, respectively. RVD was found in 26%.
In all participants, qualitative criteria were 92%(95% CI: 78% to 98%) sensitive and 64% specific(95% CI: 53% to 73%) for RVD, and quantitative criteria were 82% (95% CI: 68% to 88%) sensitive and 61% specific (95% CI:52% to 71%) for RVD. In the subgroup of participants with elevated troponin, qualitative criteria were 100% sensitive(95% CI = 88% to 100%) and 63% specific (95% CI: 51% to 74%). Subgroup analysis for participants who received reperfusion therapies and optimal cut-point analyses are ongoing.

Conclusion(s): A combination of qualitative and quantitative parameters of right ventricular involvement at PE diagnosis identifies RVD and troponin elevation in pediatric PE.