No Echo, No Problem? Predictors of Right Heart Strain Among Patients With Pulmonary Embolism
Jessica V. Downing, Stephanie Cardona, Quincy K. Tran, Daniel J. Haase, Roumen Vesselinov, Matthew Dattwyler, Taylor Miller, James A. Gerding, Kevin Jones
American Journal of Emergency Medicine, March 17, 2025
🧠Clinical Takeaways:
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When TTE is not available, use:
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CTA findings of RHS
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Heart rate, lactate, and diastolic BP
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Patient age as part of a combined clinical picture
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Low lactate + preserved DBP and younger age with only mild tachycardia may rule out RHS.
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Signs of RHS on CTA remain a strong rule-in predictor.
đź“Ś Conclusion:
In PE patients, clinical and imaging variables—specifically lactate, DBP, HR, age, and CTA findings—can reliably predict RHS in the absence of echocardiography. These can guide triage and management decisions when TTE access is limited.
🧪 Study Design:
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Population: 185 adults with PE transferred to a quaternary center (2019–2022)
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Exclusion: Patients who received thrombolytics before transfer
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Data collected:
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Vitals & labs at consult and arrival
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CTA findings (re-reviewed by study radiologist)
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TTE-confirmed RHS status
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Analysis: Hybrid classification/regression tree + logistic regression
🔍 Key Results:
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Predictive Factor |
Association with RHS on TTE |
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Lactate <2 mmol/L + DBP >63 mmHg |
OR 0.23 → 77% less likely to have RHS |
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Age <26 years + HR >90 bpm + Lactate 2–8.5 mmol/L |
OR 0.064 → 93.6% less likely to have RHS |
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Higher HR at consult |
Slightly increased likelihood of RHS (OR 1.01, p = 0.03) |
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RHS signs on CTA |
2.43x more likely to have RHS on TTE (p = 0.014) |
Downing, J.V., Cardona, S., Tran, Q.K., Haase, D.J., Vesselinov, R., Dattwyler, M., Miller, T., Gerding, J.A. and Jones, K., 2025. No Echo, no problem? Predictors of right heart strain among patients with pulmonary embolism. The American Journal of Emergency Medicine.