Right ventricular function in acute pulmonary embolism: a combined assessment by three-dimensional and speckle-tracking echocardiography

Antonio Vitarelli; Francesco Barillà; Lidia Capotosto; Ilaria D'Angeli; Giovanni Truscelli; Melissa De Maio; Rasul Ashurov

doi:10.1016/j.echo.2013.11.013

Right ventricular function in acute pulmonary embolism: a combined assessment by three-dimensional and speckle-tracking echocardiography

J Am Soc Echocardiogr. 2014 Mar;27(3):329-38. doi: 10.1016/j.echo.2013.11.013. Epub 2013 Dec 8.

Authors

Antonio Vitarelli¹, Francesco Barillà², Lidia Capotosto², Ilaria D'Angeli², Giovanni Truscelli², Melissa De Maio², Rasul Ashurov²

Affiliations

¹ Sapienza University, Rome, Italy. Electronic address: vitar@tiscali.it.
² Sapienza University, Rome, Italy.

PMID: 24325961
DOI: 10.1016/j.echo.2013.11.013

Abstract

Background: The aim of this study was to assess changes in right ventricular (RV) parameters determined by three-dimensional (3D) echocardiography and speckle-tracking echocardiography in patients with acute pulmonary embolism and RV dysfunction without systemic hypotension (submassive pulmonary embolism).

Methods: Sixty-six patients were prospectively studied at the onset of the acute episode and after median follow-up periods of 30 days and 6 months. Sixty-six controls were selected. RV fractional area change, tricuspid annular plane systolic excursion, and myocardial performance index were determined. RV systolic pressure was assessed using continuous-wave Doppler echocardiography. Three-dimensional RV ejection fraction (RVEF) was calculated. Two-dimensional peak systolic RV longitudinal strain (RVLS) was measured in the basal free wall, mid free wall (MFW), and apical free wall and the septum.

Results: Tricuspid annular plane systolic excursion and fractional area change were smaller and myocardial performance index was larger compared with controls (P < .05). Global RVLS (P < .05), MFW RVLS (P < .001), and 3D RVEF (P < .001) were lower in patients with pulmonary embolism than in controls. There was earlier reversal of MFW RVLS values on 30-day follow-up and longer reversal of 3D RVEF and RV systolic pressure values at 6-month follow-up. Receiver operating characteristic curve analysis showed that changes in 3D RVEF and MFW RVLS were the most sensitive predictors of adverse events. By multivariate analysis, RV systolic pressure (P = .007), MFW RVLS (P = .002), and 3D RVEF (P = .001) were independently associated with adverse outcomes.

Conclusions: Acute submassive pulmonary embolism has a significant impact on RV function as assessed by 3D echocardiography and speckle-tracking echocardiography. Decreases in MFW RVLS and 3D RVEF may persist during short-term and long-term follow-up and correlate with unfavorable outcomes.

Keywords: Echocardiography; Pulmonary embolism; Right ventricular function; Speckle-tracking echocardiography; Three-dimensional echocardiography.

MeSH terms

Acute Disease
Echocardiography, Three-Dimensional / methods*
Elastic Modulus
Elasticity Imaging Techniques / methods*
Female
Humans
Image Enhancement / methods
Image Interpretation, Computer-Assisted / methods
Male
Multimodal Imaging / methods*
Pulmonary Embolism / complications
Pulmonary Embolism / diagnostic imaging*
Pulmonary Embolism / physiopathology*
Reproducibility of Results
Sensitivity and Specificity
Stress, Mechanical
Ventricular Dysfunction, Right / diagnostic imaging*
Ventricular Dysfunction, Right / etiology
Ventricular Dysfunction, Right / physiopathology*