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Echocardiography is a valuable prognostic tool in patients with acute PE. Multiple studies have demonstrated that right ventricular dysfunction demonstrated by echocardiography is associated with adverse clinical outcomes. In the ICOPER study, the presence of right ventricular hypokinesis on the baseline echocar-diogram was associated with higher mortality at both 2 wk and 3 mo. In a multivariate model, the presence of right ventricular hypokinesis doubled the risk of death at 30 d.

A PASP of more than 50 mmHg at the time of diagnosis of acute PE is also associated with an adverse outcome. Additionally, the presence of a patent foramen ovale in patients with a PE and echocardiography evidence of acute right ventricular pressure overload and/or pulmonary hypertension is an adverse predictor and identifies another high-risk subset. Finally, the presence of intracardiac thrombi in patients with PE identifies a high-risk group.

Table 2

Pulmonary Arterial Hypertension: Clinical Classification

Pulmonary arterial hypertension (primary and secondary):

• Primary idiopathic pulmonary hypertension (plexogenic pulmonary arteriopathy)

• Secondary to connective tissue diseases, congenital heart disease (e.g. left-to-right shunts: atrial septal defect, ventricular septal defect, patent ductus arteriosus), drugs/toxins, portal hypertension, HIV, other direct inflammatory disorders

Pulmonary venous hypertension:

• Left-sided atrial and ventricular heart disease (e.g., chronic left ventricle dysfunction)

• Left-sided valvular heart disease (e.g., mitral stenosis)

• Pulmonary vein obstruction: congenital or acquired

Pulmonary hypertension associated with pulmonary disorders and hypoxemia:

• Chronic obstructive pulmonary disease, interstitial lung disease, chronic alveolar hypoventilation, chronic high-altitude exposure

Pulmonary hypertension secondary to thrombotic and/or embolic disease

Modified from Rich S, ed. Primary pulmonary hypertension:

Executive summary from World Symposium—Primary Pulmonary

Hypertension, 1998. Available from the World Health

Organization at www.int/ncd/cvd/pph.html.

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Mitralinsuffizienz Echokardiographie

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