Admission Endothelial Activation and Stress Index and Echocardiographic RV-PA Coupling for Early Risk Stratification in Intermediate-Risk Acute Pulmonary Embolism.
Combined biomarker-echocardiography model strongly predicted early deterioration in intermediate-risk pulmonary embolism
Admission Endothelial Activation and Stress Index and Echocardiographic RV-PA Coupling for Early Risk Stratification in Intermediate-Risk Acute Pulmonary Embolism.
Intermediate-risk acute pulmonary embolism (pulmonary embolism) is clinically heterogeneous, and early deterioration may occur despite initial normotension.
We investigated whether admission Endothelial Activation and Stress Index and echocardiographic right ventricular-pulmonary arterial (right ventricular-pulmonary arterial) coupling assessed by the TAPSE/PASP ratio identify intermediate-risk pulmonary embolism patients at increased risk for an early adverse clinical outcome (early adverse clinical outcome).
This retrospective cohort study included 900 consecutive intermediate-risk acute pulmonary embolism patients admitted between 1 January 2020 and 10 June 2025.
the model separated patients likely to worsen from those unlikely, near-perfect
Early adverse clinical outcome occurred in 110 patients (12.2%).
0.42 [0.33-0.57], p < 0.001). log2-Endothelial Activation and Stress Index correlated inversely with TAPSE/PASP (Spearman rho = -0.30, p < 0.001).
In the final combined model, log2-Endothelial Activation and Stress Index (OR 1.55 per doubling, 95% CI 1.14-2.10, p = 0.005) and TAPSE/PASP per 0.1-unit decrease (OR 1.36, 95% CI 1.10-1.68, p = 0.004) remained independently associated with early adverse clinical outcome after adjustment for clinical variables, troponin, lactate, D-dimer, and C-reactive protein-to-albumin ratio.
Admission Endothelial Activation and Stress Index and impaired right ventricular-pulmonary arterial coupling may provide complementary prognostic information for early risk stratification in intermediate-risk acute pulmonary embolism.
Because this was a retrospective single-center study without external validation, these findings should be considered hypothesis-generating and should not be used as definitive treatment-escalation triggers before independent external validation.