Abstract 13148: Sex Difference and Right Ventricular Global Longitudinal Strain in Prognosis of Malignancy-Related Submassive Pulmonary Embolism

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Introduction and Hypothesis: The risk of pulmonary embolism (PE) increases in patients with malignancy. It was reported that malignancy-related PE had significantly higher mortality compared to PE without malignancy. The aim of this study was to identify predictive factors for mortality in patients with malignancy-related submassive PE. Methods: Retrospective cohort study of patients with submassive PE between 2010 and 2018. Echocardiograms were obtained within 48 hours of PE. Strain parameters were retrospectively applied using TomTec®. The primary outcome was all-cause mortality at 30 days. Univariable and multivariable analysis, receiver operator characteristic (ROC) curve and Kaplan-Meier curves were used for evaluation. Results: 82 patients were analyzed. Among patients (mean age: 65.0 ± 13.3 years, 51.2 % female), mortality at 30 days occurred in 17.1 %. In univariable analysis, sex, left ventricular diastolic diameter, right to left ventricular diastolic diameter ratio, right ventricular global longitudinal strain (RVGLS), RV free wall strain and right atrial strain were associated with 30-day mortality (p < 0.05). Multivariable analysis revealed sex and RVGLS independently associated with 30-day mortality (p = 0.007 and p = 0.036, respectively). ROC curve indicated that the best cutoff value for the absolute RVGLS to predict 30-day mortality was 17.7 % (area under the curve 0.827, sensitivity 0.917, specificity 0.672). Kaplan-Meier curves showed that male patients had higher risk of 30-day mortality compared with female patients (p = 0.029. Figure A). Patients with absolute RVGLS less than 17.7 % had 18 times higher risk compared to the other patients (p = 0.006. Figure B). Conclusions: Sex and RVGLS predicted short-term mortality in malignancy-related submassive PE more accurately. Further study is needed to validate these findings and determine the role of sex difference and RVGLS in malignancy-related submassive PE.

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