Prognostic Value of Right Ventricular Septal Longitudinal Strain in Intermediate-Risk Pulmonary Embolism

Abstract

BACKGROUND: The interventricular septum contributes 30-60% of right ventricular (RV) output. However, few studies have assessed the prognostic value of RV septal strain in pulmonary embolism (PE). We hypothesized that RV septal strain would predict 30-day mortality in patients with intermediate-risk PE. METHODS AND RESULTS: This retrospective cohort study analyzed consecutive patients with intermediate-risk PE admitted to the Penn State Health Milton S. Hershey Medical Center between 2010 and 2018. The primary outcome was 30-day all-cause mortality. RV septal strain was measured within the RV endocardium and was defined as the mean of basal, mid, and apical septal longitudinal strain. Among 251 patients, 31 (12.4%) died within 30 days of PE diagnosis. RV strain analysis was feasible in 230 (91.6%) patients. RV septal strain was significantly lower in those who died and was independently associated with 30-day mortality (P<0.001). Receiver operating characteristic curve analysis indicated 14.4% as the optimal RV septal strain cut-off value (area under the curve 0.816). Kaplan-Meier curves demonstrated that 30-day mortality risk was higher among patients with low (≤14.4%) than high (>14.4%) RV septal strain (hazard ratio 9.29; P<0.001). CONCLUSIONS: RV septal strain is a feasible and reproducible parameter with strong prognostic value in patients with intermediate-risk PE. These findings highlight the central role of the interventricular septum in RV function and risk stratification.

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BibTeX RIS

BibTeX

@article{eguchi2026prognostic,
  title = {{Prognostic Value of Right Ventricular Septal Longitudinal Strain in Intermediate-Risk Pulmonary Embolism}},
  author = {Ayumi Eguchi and Shunsuke Eguchi and Yoshiyuki Orihara and Michael Pfeiffer and Brandon Peterson and Mohammed Ruzieh and John Boehmer and John Gorcsan III and Ryan Wilson},
  journal = {Circulation Journal},
  year = {2026},
  month = sep,
  doi = {10.1253/circj.cj-25-1133},
  url = {https://www.jstage.jst.go.jp/article/circj/90/10/90_CJ-25-1133/_article},
  note = {CC BY-NC-ND},
}

RIS

TY  - JOUR
TI  - Prognostic Value of Right Ventricular Septal Longitudinal Strain in Intermediate-Risk Pulmonary Embolism
AU  - Ayumi Eguchi
AU  - Shunsuke Eguchi
AU  - Yoshiyuki Orihara
AU  - Michael Pfeiffer
AU  - Brandon Peterson
AU  - Mohammed Ruzieh
AU  - John Boehmer
AU  - John Gorcsan III
AU  - Ryan Wilson
PY  - 2026
DA  - 2026/09/25
JO  - Circulation Journal
DO  - 10.1253/circj.cj-25-1133
UR  - https://www.jstage.jst.go.jp/article/circj/90/10/90_CJ-25-1133/_article
AB  - BACKGROUND: The interventricular septum contributes 30-60% of right ventricular (RV) output. However, few studies have assessed the prognostic value of RV septal strain in pulmonary embolism (PE). We hypothesized that RV septal strain would predict 30-day mortality in patients with intermediate-risk PE. METHODS AND RESULTS: This retrospective cohort study analyzed consecutive patients with intermediate-risk PE admitted to the Penn State Health Milton S. Hershey Medical Center between 2010 and 2018. The primary outcome was 30-day all-cause mortality. RV septal strain was measured within the RV endocardium and was defined as the mean of basal, mid, and apical septal longitudinal strain. Among 251 patients, 31 (12.4%) died within 30 days of PE diagnosis. RV strain analysis was feasible in 230 (91.6%) patients. RV septal strain was significantly lower in those who died and was independently associated with 30-day mortality (P<0.001). Receiver operating characteristic curve analysis indicated 14.4% as the optimal RV septal strain cut-off value (area under the curve 0.816). Kaplan-Meier curves demonstrated that 30-day mortality risk was higher among patients with low (≤14.4%) than high (>14.4%) RV septal strain (hazard ratio 9.29; P<0.001). CONCLUSIONS: RV septal strain is a feasible and reproducible parameter with strong prognostic value in patients with intermediate-risk PE. These findings highlight the central role of the interventricular septum in RV function and risk stratification.
SN  - 1347-4820
SN  - 1346-9843
ER  -

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