To discuss the clinical and echocardiographic identification of normotensive shock in acute pulmonary embolism and propose enhancements to the diagnostic framework for detecting right ventricular dysfunction.
Approach:
Discussion of Diagnostic Framework: The article critiques the current multi-parametric diagnostic framework for detecting right ventricular dysfunction in acute pulmonary embolism and suggests incorporating venous hemodynamics.
Quantitative Surrogates: It emphasizes the need for quantitative surrogates like the TAPSE/PASP ratio to improve risk assessment and predict mortality in normotensive patients.
Venous Excess Ultrasound Score (VExUS): The article introduces VExUS as a tool to assess the relationship between venous return and cardiac function in acute pulmonary embolism, highlighting its potential role in clinical assessment.
Key Findings:
Qualitative binary RV hypokinesis predicts 30-day mortality in normotensive PE patients.
TAPSE/PASP ratio is associated with 30-day mortality and improves risk classification in clinical settings.
VExUS grades correlate with disease severity in acute PE, providing insights into patient management.
Interpretation:
The article discusses the potential for incorporating venous hemodynamics and alternative metrics to enhance clinical decision-making in acute pulmonary embolism.
Limitations:
TAPSE/PASP ratio is load dependent and may not accurately reflect RV-PA coupling during severe RV failure, which could impact its clinical utility.
TRV measurement is often inadequate in critically ill patients, limiting the use of TAPSE-based metrics in practice.
Conclusion:
The integration of venous hemodynamics and alternative metrics like VExUS may provide a more comprehensive understanding of acute pulmonary embolism.
by José Carlos Gasca-Aldama, Karen Harumi López-Rodríguez, Mario Arturo Carrasco-Flores, Juan Ángel Morales-Ferrer, Osvaldo Alexis Marché-Fernández, Marcos Vidals-Sánchez, José Ernesto Juárez-León, Mónica Libertad Moya-Alfaro, Eduardo Alberto González-Escudero
