Sex‐Related Changes in Tissue Doppler Imaging Parameters Among Patients With Acute Pulmonary Thromboembolism

Abstract

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.

Pulmonary Embolism in Women: A Systematic Review of the Current Literature

“…Based on a Serbian study, RVSP on echo, embolic burden score on MDCT-PA, and frequencies of typical EKG signs were similar among both sexes [ 42 ]. Jenab et al compared the tissue doppler parameters and found that even though the values for parameters like tricuspid annular plane systolic excursion or right ventricular (RV) peak systolic strain were not initially different among sexes, the overall improvement in these parameters was faster in men as compared to women [ 58 ]. They also concluded that the midventricular peak systolic strain could be useful to monitor the recovery process [ 58 ].…”

Gender Differences in the Symptoms, Signs, Disease History, Lesion Position and Pathophysiology in Patients with Pulmonary Embolism

“…Normotensive female PE patients were on average older and had a submassive PE stadium more frequently [ 18 ]. Changes in the right ventricle function over time during the course of a 3-month follow-up might differ between male and female patients with acute pulmonary thromboemboli, and the recovery process could be slower in females [ 19 ]. As far as we are aware, few previous reports have concerned the above four issues, and we have therefore addressed them in our study.…”