Under pressure: right ventricular and right atrial strain predict in-hospital death in cancer patients with pulmonary embolism

Abstract Background Cardio-oncology is a rapidly evolving field. Malignancy and oncologic therapies (chemotherapy, surgery), by determining a procoagulant state, are predisposing factors for venous thromboembolism and pulmonary embolism (PE). Moreover, patients with PE and cancer carry greater short- and long-term mortality than non-cancer patients with PE. Therefore, a thorough risk stratification is of utmost importance. Echocardiography plays a crucial role in evaluating the hemodynamic consequences and the risk of PE. Our purpose was to analyse cancer patients with PE hospitalised in a tertiary center, while focusing on echocardiographic parameters and their short-term prognostic impact. Methods The study retrospectively included all patients with active cancer hospitalised with PE in our cardiology department between 2016-2025. We collected data regarding the malignancy (site, stage, treatment, time from diagnosis) and the PE (risk category, anticoagulant therapy, NT pro BNP), and also a range of echocardiographic parameters with focus on the right atrium (RA) (size, atrial reservoir strain [RASres]) and the right ventricle (RV) (size, TAPSE, S wave velocity, RV global longitudinal strain [RV-GLS], RV free wall longitudinal strain [RVFW-LS]). Patients were followed for in-hospital death. Results 202 cancer patients with PE were included. Mean age in the study group was 67±12 years and 48% were men. Colo-rectal cancer (13.4%), followed by pulmonary (12.4%) and breast cancer (11.4%) had the greatest prevalence. In-hospital death was 6.4% (13 patients). Patients who died were older (74±12 vs. 67±12 years, p=0.05) and had a greater prevalence of high-risk PE (38% vs. 7%, p