Use of biomarkers or echocardiography in pulmonary embolism: the Swiss Venous Thromboembolism Registry

Background: Cardiac biomarkers and echocardiography for assessing right ventricular function are recommended to risk stratify patients with acute non-massive pulmonary embolism (PE), but it remains unclear if these tests are performed systematically in daily practice. Design and methods: Overall, 587 patients with acute non-massive PE from 18 hospitals were enrolled in the Swiss Venous Thromboembolism Registry (SWIVTER): 178 (30%) neither had a biomarker test nor an echocardiographic evaluation, 196 (34%) had a biomarker test only, 47 (8%) had an echocardiogram only and 166 (28%) had both tests. Results: Among the 409 (70%) patients with biomarkers or echocardiography, 210 (51%) had at least one positive test and 67 (16%) had positive biomarkers and right ventricular dysfunction. The ICU admission rates were 5.1% without vs. 5.6% with testing (P=0.78), and thrombolysis or embolectomy were performed in 2.8% vs. 4.9%, respectively (P=0.25). In multivariate analysis, syncope lodds ratio (OR): 3.49, 95% confidence interval (CI): 1.20-10.15; P=0.022], tachycardia (OR: 2.31, 95% CI: 1.37-3.91; P=0.002) and increasing age (OR: 1.02; 95% CI: 1.01-1.04; P<0.001) were associated with testing of cardiac risk; outpatient status at the time of PE diagnosis (OR: 2.24, 95% CI: 1.49-3.36; P<0.001), cancer (OR: 1.81, 95% CI: 1.17-2.79; P=0.008) and provoked PE (OR: 1.58, 95% CI: 1.05-2.40; P=0.029) were associated with its absence. Conclusions: Although elderly patients and those with clinically severe PE were more likely to receive a biomarker test or an echocardiogram, these tools were used in only two-thirds of the patients with acute non-massive PE and rarely in combination.