Right Ventricular Early Inflow‐Outflow Index—A new method for echocardiographic evaluation of right ventricle dysfunction in acute pulmonary embolism

Abstract

Introduction Acute pulmonary embolism (APE) is a cardiothoracic thromboembolic emergency at risk of life‐threatening. Several risk graduation algorithms may be applied to delineate short‐term mortality in patients with APE. In this study, we aim to depict the relationship between the right ventricular early inflow‐outflow (RVEIO) index, which is a Doppler‐based parameter, and the pulmonary embolism severity index(PESI) in acute pulmonary embolism. Methods In the presented study, a total of 160 patients who were diagnosed with APE using pulmonary computed tomography angiography or ventilation/perfusion scintigraphy were comprised. Patients were separated to 2 groups based on the simplified PESI (sPESI): sPESI < 1 (n = 88) and sPESI ≥ 1 (n = 72). Echocardiographic parameters, including the RVEIO index, were measured. Results There were no significant differences between the groups in age and gender distribution, or the presence of diabetes mellitus, hypertension, smoking, and history of coronary artery disease. There was a positive correlation with the mortality rate and RVEIO index; the mortality was higher in patients with a higher RVEIO index(<0.001). In receiver operating characteristic (ROC) curve analysis using a cutoff level of 14.39, RVEIO index predicted mortality with a sensitivity of 80.4% and specificity of 57.6%(ROC area under curve:0.694; 95%CI, 0.581‐0.814; P < .001). RVEIO index was higher in the sPESI ≥ 1(n:72) than in the patients with sPESI < 1(14.27 ± 2.13 vs 10.63 ± 2.09; P < .001). There was a positive correlation between RVEIO index and sPESI score(+0.428; P < .001). Conclusion As well as predicting the degree of tricuspid regurgitation (TR), the RVEIO index is well‐correlated with sPESI score and is associated with mortality in patients with APE. This easily measurable parameter may be used to predict short‐term mortality in APE patients.

Right ventricle early inflow‐outflow index may inform about the severity of pneumonia in patients with COVID‐19

“…Recently, the RV early inflow-outflow (RVEIO) index has been identified as a possible and indirect marker of the severity of tricuspid regurgitation and RV dysfunction in pulmonary embolism. 8,9 Previous studies have emphasized that ultrasonographic examinations, especially lung ultrasound (LUS), can provide information about the lung involvement and the severity of pneumonia in COVID-19 patients. 10,11 However, no study was found in the literature investigating the relationship between echocardiographic parameters and the severity of pneumonia.…”

The RVEIO and RV function: More, please

“…In COVID-19, 11,12 RV abnormalities can be noted in 66%, and moderate or severe TR in 21% of patients, 11 both of which could elevate RVEIO, the former being related to COVID-19 mortality. 12 The current study is one of only three early RVEIO studies, [2][3][4] one of which actually showed no association between RVEIO and mortality in COVID-19. 4 To understand this discrepancy, we must first realize the preliminary nature of this area of study.…”

“…We found the article by Kahyaoglu M et al 1 on the right ventricular early inflow-outflow (RVEIO) index intriguing, but accompanied by only a meager amount of other publications on this topic. [2][3][4] The study evaluated the RVEIO index with COVID-19 pneumonia severity, and we, like Oliver, are left wanting more.…”

“…As the RV fails, the RVEIO increases markedly with afterload mismatch, as exemplified by values of >14 for severe pulmonary embolism. 3 Akin to LV dysfunction in LVEIO, intrinsic RV dysfunction can also result in elevated right atrial filling pressures and a higher RVEIO, even in the absence of severe TR. In COVID-19, 11,12 RV abnormalities can be noted in 66%, and moderate or severe TR in 21% of patients, 11 both of which could elevate RVEIO, the former being related to COVID-19 mortality.…”

“…Therefore, the current study's mean RVEIO of 5.7 ± 1.6 in severe COVID-19 pneumonia is: (a) not unlike the overall mean value of 5.2 ± 1.6 in an unselected echo referral population without COVID-19, 2 (b) larger than the value of 3.3 ± 1.3 of patients who actually died of COVID-19 reported in a previous study, 4 and (c) much lower than the >10-14 thresholds used to determine severe TR 2 and pulmonary embolism. 3 The effect of differing HR, preload and chronic remodeling on RVEIO are unknown, as is whether RVEIO behaves linearly over physiologic cardiac outputs.…”