Abstract
<title>Abstract</title> <p>Background Acute pulmonary embolism (PE) is a leading cause of cardiovascular morbidity and mortality worldwide. Right ventricular dysfunction (RVD) reflects acute haemodynamic compromise and is a recognised prognostic marker in PE, yet data on its prevalence, clinical correlates, and association with mortality remain limited in sub-Saharan Africa and, specifically, Somalia, where diagnostic and management capacity differs substantially from high-income settings. Objective To describe the clinical characteristics, prevalence, and correlates of right ventricular dysfunction among patients with acute pulmonary embolism, and to identify independent predictors of in-hospital mortality, at a tertiary referral centre in Mogadishu, Somalia. Methods This retrospective cross-sectional study included 293 adults (≥ 18 years) with acute PE confirmed by computed tomographic pulmonary angiography (CTPA), admitted to the Mogadishu Somalia-Türkiye Recep Tayyip Erdoğan Training and Research Hospital between January 2020 and December 2023. RVD was defined as right ventricular systolic and/or diastolic dysfunction documented on echocardiography or CTPA. Demographic, clinical, comorbidity, and outcome data were extracted from medical records. Bivariate associations were assessed using chi-square tests, and multivariable logistic regression identified independent predictors of in-hospital mortality. Results Among 293 patients (mean age 59.2 years; 68.6% female), RVD was present in 110 (37.5%). Compared with patients with normal right ventricular function, those with RVD were significantly more likely to have hypertension (46.4% vs 34.4%, p = 0.042), require ICU admission (92.7% vs 59.0%, p < 0.001), and present with hypoxia (91.8% vs 58.5%, p < 0.001) and syncope (12.7% vs 1.6%, p < 0.001). Overall in-hospital mortality was 17.4% (51/293) and was markedly higher among patients with RVD (29.1% vs 10.4%, χ² = 16.73, p < 0.001). On multivariable analysis, RVD was the only independent predictor of in-hospital mortality (adjusted odds ratio [aOR] 2.55, 95% CI 1.30–5.04, p = 0.007) after adjustment for age, sex, hypertension, diabetes mellitus, hypoxia, and ICU admission; none of these covariates reached statistical significance. Conclusions RVD was common among Somali patients with acute PE (37.5%) and independently conferred more than a two-fold increase in the odds of in-hospital death. These findings support the systematic integration of right ventricular assessment into PE diagnostic and triage pathways in resource-limited settings, to improve prognostic accuracy and guide allocation of intensive care resources.</p>