Echocardiographic Dysfunction in Intermediate-Risk Pulmonary Embolism and Its Association with Short-Term Outcomes in a Pakistani Cohort

Abstract

Objectives: Pulmonary embolism (PE) is a major contributor to cardiovascular-related morbidity and mortality worldwide. While right ventricular dysfunction (RVD) is a well-established prognostic marker, the impact of left ventricular dysfunction (LVD) in PE remains less clearly defined. This study aimed to determine the prevalence and prognostic significance of echocardiographic dysfunction in patients with intermediate-risk (submassive) PE in a Pakistani population. Methodology: A retrospective observational study was conducted from January 2022 to September 2024 at Aga Khan University Hospital, Karachi. Patients with intermediate-risk PE were identified, and echocardiographic parameters of right and left ventricular function were assessed. Outcomes included in-hospital mortality, hemodynamic decompensation, and 30-day mortality. Results: A total of 109 patients were included (median age 60 years, IQR 42–72.5; 51.4% males). Of these, 41.3% were categorized as intermediate-high risk, and 58.7% as intermediate-low risk. Thrombolytic therapy was administered to 26 patients. Echocardiography revealed RVD in 48.6% and LVD in 13.8% of patients. LVD was associated with higher rates of decompensation (28.6% vs. 12.2%) and 30-day mortality (20% vs. 9.6%), though these differences were not statistically significant. Conversely, RVD was significantly associated with adverse outcomes, including increased in-hospital mortality (17% vs. 1.8%, p=0.006), decompensation (24.5% vs. 1.8%, p<0.001), and adverse event rates (35.8% vs. 10.7%, p=0.02). Overall, in-hospital mortality was 8.3% and 30-day mortality was 11%.No statistically significant differences were observed in patients who received thrombolytics when compared with anti-coagulation (11.2% vs 7.2% p-value 0.486). Conclusion: LVD was identified in a subset of intermediate-risk PE patients, showing a trend toward poorer short-term outcomes. RVD, however, remained a stronger and statistically significant predictor of adverse outcomes. These findings underscore the need for individualized risk stratification and incorporation of LV assessment into prognostic models for PE management in South Asian populations.