Identification of pulmonary thromboembolism (PTE), as a cause of syncope, is important and may be life saving. We prospectively analyzed data on 335 patients with acute PTE. Relationships between syncope secondary to acute PTE and clinical findings, risk factors, and imaging modalities were analyzed. Of the 335 patients, 36 (10.7%) had syncope at presentation. Compared to patients without syncope, those with syncope had a higher frequency of right ventricular (RV) dysfunction (94.3% vs 72.1%, respectively; P value = .004) and saddle embolism (24.2% vs 10.9%, respectively; P value = .044). Frequency of RV dysfunction was similar between patients with and without saddle embolism. Although not significant, more patients with syncope had a history of previous PTE (P value = .086). By multivariable analysis, RV dysfunction and saddle embolism were independent correlates of syncope in patients with PTE. In-hospital mortality was not significantly different between the groups. In conclusion, among patients with PTE, RV dysfunction and saddle embolism were the independent correlates of syncope.

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ConclusionBy means of the presented case, we emphasize the importance of pre-procedural imaging of PV anatomy and suggest electrical disconnection of all PV variants as far as possible. If available, utilization of an image integration system combining electro-anatomic mapping images with reconstructed 3-dimensional CT scans can offer ease and safety when performing similar complex ablation procedures.

n acute pulmonary thromboembolism, the right ventricular (RV) function has been shown to be an important predictor of the clinical outcome and should be taken into account during clinical management and treatment. 1 In patients with acute pulmonary thromboembolism, in-hospital mortality rates for those with RV systolic dysfunction (instead of afterload stress) are high and reach 19.7% in comparison to patients without RV systolic dysfunction (5.7%). 2 Assessment of the RV structure and function in most clinical practices remains qualitative, 3,4 and an objective assessYaser Jenab, MD, Neda Ghaffari-Marandi, MD, Azam Safir, MD, Gita Ejmalian, MD, Arezou Zoroufian, MD, Arash Jalali, PhD, Mohammad Sahebjam, MD Received December 29, 2012, Methods-Between September 2010 and September 2011, 41 of 64 hemodynamically stable acute patients with pulmonary thromboembolism were included in the study. Twenty-two healthy individuals served as a control group.Results-Compared to the control group, the acute pulmonary thromboembolism group had a lower tricuspid annular plane systolic excursion, basal peak systolic velocity of the tricuspid valvular annulus, right ventricular (RV) peak systolic strain, and RV peak systolic strain rate and a higher RV diameter, peak systolic pulmonary artery pressure, and RV myocardial performance index (P < .05). Values for these parameters were not different between men and women in the patient group. In men, compared to admission, predischarge echocardiography showed significant improvement in the tricuspid annular plane systolic excursion (mean ± SD, 16.08 ± 4.33 versus 19.29 ± 3.74 mm; P = .002), basal tricuspid annular peak systolic velocity (10.11 ± 3.66 versus 11.66 ± 3.38 cm/s; P = .007), and peak systolic strain (-13.00% ± 14.99% versus -23.20% ± 10.23%; P = .001), whereas in women, predischarge and 3-month follow-up echoacrdiography showed marked improvement in the tricuspid annular plane systolic excursion (17.50 ± 4.88 versus 19.79 ± 5.58 mm; P = .021) and peak systolic strain (-15.70% ± 13.52% versus -21.01% ± 10.57%, respectively; P= .045). Female patients did not show improvement in these parameters during hospitalization.Conclusions-Patterns of changes in the RV function over time during a 3-month followup might differ between male and female patients with acute pulmonary thromboembolism, and the recovery process could be slower in women. Moreover, the midventricular peak systolic strain might be useful for serial evaluation of the recovery process.

Tissue Doppler-derived peak systolic strain of RV mid-ventricular wall may be potentially useful in the serial quantification of improvement in RV function in response to thrombolytic therapy in acute PTE.