Assessment of right ventricular function and relation to mortality after acute pulmonary embolism: A speckle tracking echocardiography‐based study

Abstract

Purpose Right ventricular (RV) dysfunction is a common condition that is related to increased adverse outcomes in patients with acute pulmonary embolism (APE). Our aim was to assess timing and magnitude of regional RV function using speckle tracking echocardiography (STE) and to evaluate their relationship to long‐term mortality in patients after APE. Methods In total, 147 patients were enrolled at the onset of an APE episode and followed for 12 ± 1.1 months. For all patients, the clinical, laboratory, and echocardiography examinations were performed at the diagnosis of APE and at the end of the 1‐year follow‐up. Results Of the 147 patients, 44 (29.9%) died during the 1‐year follow‐up after APE. The patients who died had lower RV free wall peak longitudinal systolic strains (PLSS) and left ventricular (LV) PLSS and higher RV peak systolic strain dispersion (PSSD) index which means the electromechanical dispersion when compared with the survivors. The difference in time to PLSS between the RV free wall and LV lateral wall (RVF–LVL) which means the electromechanical delay was longer in patients who died than in those who survived during follow‐up, and this difference was an independent predictor of mortality at 1 year of follow‐up after APE, with 86.4% sensitivity and 81.7% specificity. At the end of 1‐year follow‐up, the RV free wall PLSS and the LV global PLSS increased, whereas the RV PSSD index and the difference in time to PLSS between the RVF and LVL decreased. Conclusions Acute pulmonary embolism was associated with RV dysfunction and RV electromechanical delay and dispersion. These parameters improved at the end of 1‐year follow‐up. The electromechanical delay index might be a useful predictor of mortality in patients after APE.

Indexing of Speckle Tracking Longitudinal Strain of Right Ventricle to Body Surface Area Does Not Improve Its Efficiency in Diagnosis and Mortality Risk Stratification in Patients with Acute Pulmonary Embolism

“…Similar findings come from the publication by Lee et al, in which RVGLS and RVFWLS independently predicted in-hospital vents: death, the need for additive treatments such as thrombolysis or pulmonary artery thromboembolectomy, and the need for inotropes due to unstable vital signs [35]. RVFWLS was also a predictor of mortality in patients after acute PE in a longer 12-month follow-up [36].…”

Evaluating the Right Ventricle in Acute and Chronic Pulmonary Embolism: Current and Future Considerations

“…The most spherical shape assumed by the RV in acute PE to normalize regional wall stress leads to bulging of the free wall relative to the RV base and apex, and leads to disproportionate decline in mid-free wall strain values. 35,[39][40][41][42]…”

“…32,49,50 Low RV free wall strain has also been noted to be an adverse prognostic marker in PE patients. 41,42 Recently, Doppler velocity time integrals (surrogate measure for stroke volume) for LV and RV outflow tracts have been shown to predict adverse outcomes (death, cardiac arrest, hemodynamic deterioration). 51,52 Enlarged RV dimensions on chest CT signify RV dysfunction and predict adverse outcomes in PE patients.…”

Endovascular Treatment of Acute Pulmonary Embolism: A Rapid Evolution

“…For example, speckle tracking parameters such as peak longitudinal strain may be helpful in predicting mortality after acute PE. 5 In addition, Afonso et al recently described early systolic notching of the pulsed-waved Doppler envelope at the right ventricular outflow tract as a highly specific marker of acute massive or submassive PE; early systolic notching was 99% specific with an area under the receiver operating characteristic curve of 0.96 for PE compared with control patients without PE. 6 The area under the receiver operating characteristic curve is compelling for this finding, and perioperative physicians may wish to consider right ventricular outflow tract pulsed-wave Doppler after assessment of right ventricular morphology and function when evaluating patients who may have PE.…”