Abstract 13141: Max Opposing Wall Delay in Right Atrial Strain Can Be a Prognostic Factor at 30-day Mortality in Submassive Pulmonary Embolism

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Background: Submassive pulmonary embolism (sPE) is common and associated with significant mortality. Right ventricular dyssynchrony caused by sPE were reported previously. However, limited studies have evaluated dyssynchrony of right atrium (RA) strain in the setting of sPE. The purpose of this study was to identify the potential role of RA dyssynchrony in patients with sPE. Methods: 201 patients with sPE were assessed in this retrospective cohort study. All echocardiograms were completed within 48 hours of diagnosis. RA strain was analyzed retroactively using TOMTEC®. RA dyssynchrony was defined as absolute max opposing wall delay which was time interval between peak lateral and septal wall strain in RA after R-R interval correction (maxOWD) (Figure 1). The primary outcome was 30-day all-cause mortality. Results: 201 patients included in the study. Mortality rate of 11.4% was seen at 30 days. Median maxOWD in survivors was significantly low compared to that in non-survivors (4.35 vs 16.20, p < 0.001). Univariable and Multivariable analysis showed maxOWD was an independent factor to predict short-term mortality. Receiver operating characteristics (ROC) analysis revealed area under the curve was 0.795 and best cutoff value was 10.43. Using the cutoff value, Kaplan-Meier curves depicted survival rate in patients with maxOWD > 10.43 was significantly lower than those with maxOWD ≤ 10.43. (Hazard Ratio 7.84, p < 0.001) (Figure 2) Conclusions: Max opposing wall delay after R-R interval correction in RA strain has significant prognostic value in assessing risk of mortality in patients with submassive PE.

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