PB0930 - Hypoxia and right ventricular strain in patients with acute pulmonary embolism

Monday, June 24, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Co-Author(s)

KS

Karsten Stannek

Research Collaborator, Center for Vascular Emergencies
Massachusetts General Hospital
Dusseldorf, Nordrhein-Westfalen, Germany

Co-Author(s)

Eun Sang Lee

Research Collaborator, Center for Vascular Emergencies
Massachusetts General Hospital
Dublin, Dublin, Ireland
KC

Kyle Chang

Research Collaborator, Center for Vascular Emergencies
Massachusetts General Hospital, Boston MA
Boston, Massachusetts, United States
ML

Mads Dam Lyhne

Researcher
Department of Cardiology, Aarhus University Hospital and Institute of Clinical Medicine
Aarhus, Midtjylland, Denmark
VM

Victor Tang Merit

Medical Researcher
Department of Cardiology, Aarhus University Hospital and Institute of Clinical Medicine
Aarhus, Midtjylland, Denmark
TM

Timothy Matthews BS

Research Collaborator, Center for Vascular Emergencies
Massachusetts General Hospital
Boston, Massachusetts, United States
GW

Grace Wang MS MPH

Clinical Research Coordinator
Massachusetts General Hospital, Boston MA
Boston, Massachusetts, United States
NH

Nora Horick MS

Biostatistician
Massachusetts General Hospital, Boston MA
Boston, Massachusetts, United States
ID

Isabel Dhar

Research Coordinator, Center for Vascular Emergencies
Massachusetts General Hospital
Boston, Massachusetts, United States

Presenting Author(s)

Christopher Kabrhel, MD MPH

Director, Center for Vascular Emergencies
Massachusetts General Hospital
Boston, Massachusetts, United States

Co-Author(s)

CP

Christiana Prucnal

Researcher
Center for Vascular Emergencies
Boston, Massachusetts, United States
SH

Savanah Harshbarger MD MBA

Resident Physician, Harvard Affiliated Emergency Medicine Residency Program
Massachusetts General Hospital, Boston, MA
Boston, Massachusetts, United States
DB

Drew Birrenkott DPhil MD

Resident Physician, Harvard Affiliated Emergency Medicine Residency
Massachusetts General Hospital
Boston, Massachusetts, United States
TB

Tyleah Brown

Research Coordinator, Center for Vascular Emergencies
Massachusetts General Hospital
Boston, Massachusetts, United States
SF

Sophie Flomenbaum

Research Coordinator
Massachusetts General Hospital
Boston, Massachusetts, United States

Background: In acute pulmonary embolism (PE) patients, right ventricular strain (RVS) is a key prognostic factor. Hypoxia may increase pulmonary vascular resistance, potentially worsening RVS. However, the relationship between hypoxia and RVS and its impact on clinical outcomes is not well understood.

Aims: To compare the relationship between hypoxia and RVS across distinct patient subgroups with PE.

Methods: We performed a retrospective, single-center cohort study on patients treated by the Massachusetts General Hospital Pulmonary Embolism Response Team (PERT) from 10/2012-01/2021. Inclusion criteria included confirmed PE, recorded oxygen saturation prior to PERT activation, and echocardiogram within three days of PERT activation. Patients were categorized into four subgroups based on hypoxia status and oxygen support (Table 1). We defined right ventricular strain (RVS) as RV dilatation, RV hypokinesis, septal bowing, or right ventricular systolic pressure > 36 mmHg. Our composite outcome of clinical deterioration included: death, need for thrombolysis or thromboembolectomy, ECMO, or hypotension requiring vasopressors within 7 days.

Results: Among 785 patients, mean ages were 61 (non-hypoxic) and 66 (hypoxic) years. 151/381 (40%) females and 149/404 (37%) males were non-hypoxic; 230/381 (60%) females and 251/404 (62%) males were hypoxic. 495/785 (635%) had RVS on echocardiogram, which was more common in the hypoxic group (n=403/481, 84%), see Table 1. RVS prevalence was highest in the hypoxic with oxygen support subgroup (n=241/785, 31%). RVS was associated with oxygen support, regardless of hypoxia status, affecting 225/297 (76%) with oxygen support 274/483 (57%) patients without support. Clinical deterioration occurred in 160 (20%) patients, predominantly in the hypoxic group (n=135, Table 2).

Conclusion(s): Hypoxia and oxygen support are associated with RVS and adverse outcomes in PE patients. More research is needed to understand the relationship between hypoxia, oxygen support, RVS and clinical outcomes in patients with PE.