Background: Certain echocardiographic parameters may serve as early predictors of adverse events in patients with hemodynamically compromising pulmonary embolism (PE). Methods and Results: An observational analysis was conducted for patients with acute pulmonary embolism evaluated by a Pulmonary Embolism Response Team (PERT) between 2014 and 2020. The performance of clinical prediction algorithms including the Pulmonary Embolism Severity Index and Carl Bova score were compared using a ratio of right ventricle and left ventricle hemodynamics by dividing the pulmonary artery systolic pressure by the left ventricle stroke volume. The primary outcome of in‐hospital mortality, cardiac arrest, and the need for advanced therapies was evaluated by univariate and multivariable analyses. Of the 343 patients meeting the inclusion criteria, 215 had complete data. Pulmonary artery systolic pressure/left ventricle stroke volume was a clear predictor of the primary end point (odds ratio [OR], 2.31; P =0.005), performing as well or better than the Pulmonary Embolism Severity Index (OR, 1.43; P =0.06) or the Bova score (OR, 1.28; P =0.01). Conclusions: This study is the first study to demonstrate the utility of early pulmonary artery systolic pressure/left ventricle stroke volume in predicting adverse clinical events in patients with acute pulmonary embolism. Pulmonary artery systolic pressure/left ventricle stroke volume may be a surrogate marker of ventricular asynchrony in high‐risk pulmonary embolism and should be prognostically evaluated.

Background: While obesity is associated with an increased risk of venous thromboembolism (VTE), there is some data to suggest that higher BMI is also associated with decreased all-cause mortality in patients with a pulmonary embolism (PE). Methods: Using PE Response Team (PERT) activation data from a large tertiary hospital between 27 October 2020 and 28 August 2023, we constructed a multivariate Cox proportional hazards model to assess the association between obesity as a dichotomous variable (defined as BMI ≥ 30 vs. BMI 18.5–29.9), BMI as a continuous variable, and 30-day PE-related mortality. Results: A total of 248 patients were included in this analysis (150 with obesity and 98 who were in the normal/overweight category). Obesity was associated with a lower risk of 30-day PE-related mortality (adjusted HR 0.29, p = 0.036, 95% CI 0.09–0.92). A higher BMI was paradoxically associated with a lower risk of PE-related mortality (HR = 0.91 per 1 kg/m² increase, p = 0.049, 95% CI 0.83–0.999). Conclusions: In our contemporary cohort of patients with a PERT activation, obesity was associated with a lower risk of PE-related mortality.

• Thrombus age determines inflammatory and fibrotic capabilities through activation of enzymes that are known to damage the blood vessel wall. • Chronic thrombus in veins has greater MMP9 activity than more acute thrombus in arteries, with MMP9 appearing to be derived from macrophages trapped in thrombus.

PURPOSE: Cancer-associated thrombosis (CAT) is a significant cause of morbidity and mortality. Significant gaps exist in adherence to guidelines suggesting the use of primary thromboprophylaxis in high-risk patients with cancer. Our goal was to understand gaps in patients' awareness of CAT and thromboprophylaxis to better inform future outreach efforts within the framework of shared decision making between patients and providers. PATIENTS AND METHODS: A bilingual (in English and Spanish) questionnaire was designed for individuals with a history of cancer or active cancer by a multidisciplinary expert group including patient advocates, pilot tested and electronically circulated through nonprofit patient advocacy groups for thrombosis and cancer in the United States. Survey domains included (1) risk factor awareness, (2) clinical presentation/diagnosis, (3) treatment, and (4) prevention. We received responses from 140 patients, 41% of whom were actively receiving cancer treatment. RESULTS: Patients demonstrated significant knowledge gaps with regard to CAT, with 61% of patients being unaware of the higher risk of thrombosis in cancer. Patients were open to receiving more information about CAT, including 80% who would like to receive more information from their clinician. A total of 71% of patients would consider the use of thromboprophylaxis if discussed with their provider; however, patients endorsed several concerns about its use including bleeding risk, polypharmacy, and medication interactions. CONCLUSION: Our study demonstrated that there remain significant knowledge gaps regarding CAT and thromboprophylaxis in American patients with cancer. Clinicians remain a trusted source of information about clotting, and a majority of patients are willing to consider thromboprophylaxis if discussed with their provider. Patient education will be an important aspect of increasing adherence to thromboprophylaxis guidelines in high-risk patients with cancer.