Sex-related differences in echocardiography parameters for predicting in-hospital mortality in patients with acute pulmonary embolism
TL;DR
In patients with acute PE, TAPSE measured at admission in women, but not in men, was the only echocardiographic parameter independently associated with all-cause in-hospital mortality.
Abstract
Background Risk stratification of acute pulmonary embolism (PE) is primarily based on systolic arterial pressure, right ventricular (RV) function, and cardiac troponin levels. Objectives To investigate sex-related differences in simple RV echocardiographic parameters for predicting all-cause in-hospital mortality in acute PE. Design Multicenter, observational, retrospective, registry-based cohort study. Methods We analyzed data from the Regional Pulmonary Embolism Registry, including consecutive patients with acute PE confirmed by computed tomography pulmonary angiography between January 2015 and January 2026. Of 2776 patients, 2408 had at least one RV echocardiographic parameter measured at admission (RV diastolic diameter, RV systolic pressure, tricuspid annular plane systolic excursion [TAPSE], and ratio TAPSE/RV systolic pressure). Multivariable Cox regression adjusted for age, sex-specific differences, and shock at admission (systolic arterial pressure <90 mmHg), was used to identify predictors of all-cause in-hospital mortality. Sex-specific cutoffs of echocardiographic parameters with the strongest predictive value for all-cause mortality were determined using a decision tree. Results All-cause in-hospital mortality rates were similar between men (7.6%, 83/1125) and women (9.2%, 118/1283; p=0.107). TAPSE was the only echocardiographic parameter independently associated with all-cause in-hospital mortality in women (adjusted hazard ratio [95% confidence interval] 0.84 [0.77–0.90], p<0.001), but not in men (0.92 [0.85–1.01], p=0.075). Decision-tree analyses identified TAPSE cutoffs of >19 mm for women and >16 mm for men, enabling discrimination between low- and high-risk patients. Mortality was 10.2% versus 0.9% in women (≤19 vs. >19 mm, p<0.001) and 9.0% versus 2.5% in men (≤16 vs. >16 mm, p=0.001). In women, TAPSE >19 mm identified a subgroup with very low in-hospital mortality (1.4%) and an excellent negative predictive value (98.6%). Conclusion In patients with acute PE, TAPSE measured at admission in women, but not in men, was the only echocardiographic parameter independently associated with all-cause in-hospital mortality.