Timing and Magnitude of Regional Right Ventricular Function and Their Relationship with Early Hospital Mortality in Patients with Acute Pulmonary Embolism

Abstract

Objective: Right ventricular (RV) dysfunction in acute pulmonary embolism (APE) has been associated with increased mortality and morbidity. The aim of the present study was to assess the timing and magnitude of regional RV functions using speckle-tracking echocardiography (STE) and their relationship to early hospital mortality in patients with APE. Methods: One hundred forty-two patients were prospectively studied at the onset of an acute episode and after a median follow-up period of 30 days. Their clinical and laboratory characteristics were recorded. For all patients, conventional two-dimensional echocardiography and STE were performed within 24 h after the diagnosis of APE. Results: Twenty-eight (19.7%) patients died during the hospitalization follow-up. Patients who died during hospitalization were older and had higher high sensitivity cardiac troponin T levels, and a higher percentage of patients had simplified Pulmonary Embolism Severity Indexes. In STE analyses, they had lower RV free wall peak longitudinal systolic strain (PLSS) and higher RV peak systolic strain dispersion indexes. The time to PLSS difference between RV free wall and LV lateral was longer in patients who died during hospitalization than in those who survived, and this was an independent predictor of early hospital mortality with 85.7% sensitivity and 75.0% specificity in patients with APE. Conclusion: APE was associated with RV electromechanical delay and dispersion. Electromechanical delay index might be useful to predict early hospital mortality in patients with APE.

Prognostic role of different findings at echocardiography in acute pulmonary embolism: a critical review and meta-analysis

“…The role of RV/LV ratio as predictor of clinical course in patients with acute PE was reported in 16 studies [10,11,23,24,28,45,[60][61][62][63][64][65][66][67][68][69] (Supplementary Table 2).…”

“…Fourteen observational studies assessed the role of TAPSE in the prediction of short-term death [10,11,45,60,[62][63][64][65][70][71][72][73][74][75] (Supplementary Table 3). A formal meta-analysis on the association between TAPSE and clinical outcome is reported below.…”

“…A meta-analysis on the prognostic role of RV diameter is reported below. Of all included studies, four reported long-term outcomes (605 patients): two studies assessed the association between RV/LV and long-term course of PE patients, two RVD as a combination of findings and long-term course [41,41,61,63]. RV/LV>1 was associated with an increased risk of long-term death (two studies, 331 patients) [61,62].…”

Elevated D-Dimers and Right Ventricular Dysfunction on Echocardiography for Diagnosis of Pulmonary Embolism: A Validation Study

“…Transthoracic echocardiography (TTE) was done using Aplio 300 CV ultrasound systems to look for right ventricular dysfunction. The criteria used for diagnosing this dysfunction included ratio of right ventricle to left ventricle (RV/LV), end-diastolic diameter greater than 1 in apical 4 chamber view, right ventricular end-diastolic diameter (RVEDD) greater than 30 mm, and paradoxical right ventricular septal motion [ 11 ]. In presence of thrombus in major pulmonary arteries, the right ventricular free wall shows an overall reduced contraction with sparing of the apex.…”

“…Echocardiography, transthoracic, or transesophageal is a valuable noninvasive tool in diagnosing acute massive pulmonary embolism [ 10 ]. It aids indirect visualization of thrombus in the main pulmonary artery or the right-sided cardiac chambers; right atrium (RA) and right ventricle (RV) [ 11 ]. The presence of thrombus in the pulmonary arteries can be indirectly confirmed due to unexplained dilatation or dysfunction of right ventricular with or without tricuspid valve insufficiency [ 12 ].…”