Hypoxia and right ventricular dysfunction in patients with acute pulmonary embolism
11 affiliations
- 1Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St., Suite 460, Boston, MA 02114 USA
- 2Department of Cardiology, University Medical Center Mainz, Mainz, Germany
- 3Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- 4Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- 5University College Dublin, Dublin, Ireland
- 6Department of Internal Medicine, University of Washington, Seattle, USA
- 7Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- 8University of Massachusetts Chan Medical School, Worcester, USA
- 9State College, Pennsylvania State University, University Park, USA
- 10Department of Emergency Medicine, Harvard Medical School, Boston, MA USA
- 11Department of Biostatistics, Massachusetts General Hospital, Boston, MA USA
Abstract
Background: In patients with acute pulmonary embolism (PE), hypoxia may increase pulmonary vascular resistance and worsen right ventricular dysfunction (RVD), which is a key prognostic factor. However, associations between hypoxia, RVD and clinical outcomes have not been well described.
Aim: To describe associations between hypoxia, RVD and clinical outcomes in patients with PE.
Methods: We performed a retrospective, single-center cohort study of patients treated by the Massachusetts General Hospital Pulmonary Embolism Response Team (PERT) from 10/2012 to 08/2021. Inclusion criteria included confirmed PE, recorded oxygen saturation prior to PERT activation, and echocardiogram within three days of PERT activation. Patients were categorized into four subgroups based on (1) hypoxia status (SaO₂ below vs. above 95%) and, (2) oxygen support (below vs. above 3 L/min). Our primary outcome was the presence of RVD on echocardiogram. Our secondary outcome was clinical deterioration within 7 days.
Results: We included 894 PE patients. The mean age was 61 (± 16 SD), 614/894 (69%) were hypoxic, and 624/894 (70%) had RVD on echocardiogram. Overall, hypoxic patients were more likely to have RVD than non-hypoxic patients (467/614 [76%] vs. 157/280 [56%], p < 0.0001). On subgroup analysis, RVD prevalence was highest in the “hypoxic with oxygen support ≥3L” group (n = 216/266, 81%) followed by the “not hypoxic with oxygen support ≥3L” group 53/70 (76%); 198/278 (71%) in the “hypoxic with oxygen support <3L” and 157/280 (56%) in the “not hypoxic with oxygen support <3L” groups. Clinical deterioration occurred in 199/894 (22%) patients and was more common in hypoxic patients than non-hypoxic patients (157/614 [26%] vs. 42/280 [15%], p < 0.0001), and most common in the “hypoxic with oxygen support ≥3L” subgroup 88/266 (33%).
Conclusions: Hypoxia is associated with RVD and clinical deterioration in patients with PE. More research is needed to understand the risk associated with hypoxia and the physiology of supplemental oxygen support in PE.
Clinical trial number: Not applicable.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12959-026-00931-z.
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BibTeX
@article{stannek2026hypoxia,
title = {{Hypoxia and right ventricular dysfunction in patients with acute pulmonary embolism}},
author = {Karsten Stannek and Mads Dam Lyhne and Eun Sang Lee and Kyle Elton Chang and Victor Tang Merit and Timothy M. Matthews and Grace Wang and Christiana Prucnal and Drew Alan Birrenkott and Greg Peters and Nora Horick and Isabel Dhar and Matthew Freitas and Tyleah Brown and Sophie Flomenbaum and Christopher Kabrhel},
journal = {Thrombosis Journal},
year = {2026},
month = oct,
doi = {10.1186/s12959-026-00931-z},
url = {https://doi.org/10.1186/s12959-026-00931-z},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Hypoxia and right ventricular dysfunction in patients with acute pulmonary embolism
AU - Karsten Stannek
AU - Mads Dam Lyhne
AU - Eun Sang Lee
AU - Kyle Elton Chang
AU - Victor Tang Merit
AU - Timothy M. Matthews
AU - Grace Wang
AU - Christiana Prucnal
AU - Drew Alan Birrenkott
AU - Greg Peters
AU - Nora Horick
AU - Isabel Dhar
AU - Matthew Freitas
AU - Tyleah Brown
AU - Sophie Flomenbaum
AU - Christopher Kabrhel
PY - 2026
DA - 2026/10/09
JO - Thrombosis Journal
DO - 10.1186/s12959-026-00931-z
UR - https://doi.org/10.1186/s12959-026-00931-z
AB - Background: In patients with acute pulmonary embolism (PE), hypoxia may increase pulmonary vascular resistance and worsen right ventricular dysfunction (RVD), which is a key prognostic factor. However, associations between hypoxia, RVD and clinical outcomes have not been well described. Aim: To describe associations between hypoxia, RVD and clinical outcomes in patients with PE. Methods: We performed a retrospective, single-center cohort study of patients treated by the Massachusetts General Hospital Pulmonary Embolism Response Team (PERT) from 10/2012 to 08/2021. Inclusion criteria included confirmed PE, recorded oxygen saturation prior to PERT activation, and echocardiogram within three days of PERT activation. Patients were categorized into four subgroups based on (1) hypoxia status (SaO₂ below vs. above 95%) and, (2) oxygen support (below vs. above 3 L/min). Our primary outcome was the presence of RVD on echocardiogram. Our secondary outcome was clinical deterioration within 7 days. Results: We included 894 PE patients. The mean age was 61 (± 16 SD), 614/894 (69%) were hypoxic, and 624/894 (70%) had RVD on echocardiogram. Overall, hypoxic patients were more likely to have RVD than non-hypoxic patients (467/614 [76%] vs. 157/280 [56%], p < 0.0001). On subgroup analysis, RVD prevalence was highest in the “hypoxic with oxygen support ≥3L” group (n = 216/266, 81%) followed by the “not hypoxic with oxygen support ≥3L” group 53/70 (76%); 198/278 (71%) in the “hypoxic with oxygen support <3L” and 157/280 (56%) in the “not hypoxic with oxygen support <3L” groups. Clinical deterioration occurred in 199/894 (22%) patients and was more common in hypoxic patients than non-hypoxic patients (157/614 [26%] vs. 42/280 [15%], p < 0.0001), and most common in the “hypoxic with oxygen support ≥3L” subgroup 88/266 (33%). Conclusions: Hypoxia is associated with RVD and clinical deterioration in patients with PE. More research is needed to understand the risk associated with hypoxia and the physiology of supplemental oxygen support in PE. Clinical trial number: Not applicable. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12959-026-00931-z.
SN - 1477-9560
ER -