Right atrial and ventricular function evaluated with speckle tracking in patients with acute pulmonary embolism

doi:10.1016/j.ajem.2016.09.059

The American Journal of Emergency Medicine

Volume 35, Issue 1, January 2017, Pages 136-143

https://doi.org/10.1016/j.ajem.2016.09.059 Get rights and content

Abstract

Aims

Assessment of right ventricular (RV) function in acute pulmonary embolism (PE) has prognostic significance. The aim of this study was to evaluate right atrium (RA) and RV myocardial damage with 2-dimensional speckle-tracking in patients with an acute central vs an acute peripheral PE.

Methods and Results

Twenty-six patients with acute PE and 10 controls were retrospectively enrolled. Right atrium and RV myocardial deformation was analyzed using speckle-tracking imaging echocardiography. Parameters were evaluated to illustrate myocardial damage in patients with a central or a peripherally located PE.

Thirteen of the enrolled patients had a massive central PE, and thirteen subjects had a peripheral located PE. Baseline characteristics were not significantly different between the 3 groups besides a more elevated heart rate among patients with a central PE (P = .02) and a tendency of an increased D-dimer in this group. Right ventricular dimensions were more affected among patients with a PE. Compared with controls, segmental RV and RA strain/strain rate in the free wall was significantly reduced in patients with PE (P < .05). No difference was shown between the 2 groups of PE.

Conclusion

This pilot study suggests that basal-/mid-segments of RA and RV free wall are more affected in patients with a PE compared with controls. Interestingly, we found no significant difference in myocardial RA and RV damage between patients with a central and a peripheral PE. We advocate that PE no matter central or peripheral is a serious condition and that a peripheral PE has to be intensively treated similar to a central PE.

Introduction

The assessment of right ventricular (RV) function in acute pulmonary embolism (PE) is of prognostic significance [1]. The aim of this study was to assess regional changes in RV and right atrial (RA) parameters determined, respectively, by 2-dimensional speckle-tracking (2D-STE) and standard echocardiography (2D-TTE) in patients with acute PE.

Massive acute PE is related to high in-hospital or 30-day mortality rates ranging from 4% to 13%. Extensive PE causes an acute increase in the RV afterload and may result in an RV failure [2]. Echocardiography is normally used to evaluate the RV function and so guide the choice of treatment in PE. Ultrasound is low cost, portable, real-time, and noninvasive, and often useful to detect acute PE in patients both in ward and at the emergency department (ED).

Two-dimensional STE has reformed cardiovascular imaging over the past decade. The methodology is based on standard B-mode images to track the motion of speckles over time and to measure the lengthening and shortening relative to the baseline value. This enables angle-independent assessment of myocardial mechanics, from which displacement, velocity, strain, and strain rate can be derived [3], [4].

Myocardial mechanics have been used to study primarily RV and left ventricle performance. Since 2007, strain has been applied to analyze RV and the left atrium in different clinical settings [5], [6], [7].

Section snippets

Patients and protocol

This single-center, retrospective cohort study was conducted at Amager Hospital between January 1, 2013, to April 30, 2015, and comprised patients with acute PE who were admitted to ED. Ten age-matched healthy adults served as controls (NL). We enrolled 45 patients with acute PE. Pulmonary embolism was diagnosed in 26 subjects who presented with a refilling defect in pulmonary arteries, in spiral computed tomographic angiography and/or a perfusion defects in V/Q scintigraphy [6]. Nineteen

Results

We evaluated 45 subjects. Our study enrolled 26 patients with complete datasets including both echocardiographic and hemodynamic data. We divided the patients into 2 groups; 13 patients diagnosed as having central PE and 13 patients with peripherally PE. We obtained echocardiographic data from 10 healthy individuals for comparison. Table 1 summarizes baseline characteristics of the patients. There were no significant differences between the groups except for elevated heart rate (P < .02).

Discussion

This pilot study demonstrates regional RA and RV variation in longitudinal strain/strain rates and displacement identified by 2D-STE in subjects with acute PE in comparison to NL. Two-dimensional STE could ultimately be automated and be useful in risk stratification of patients with PE in the acute care settings.

Consistent with previous observations, especially central PE, large RV chamber size and reduced RV systolic function were associated with abnormally high peripherally vascular

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^☆: Funding/Support: None.

^☆☆

Institution where work was done: Department of Cardiology, Amager Hospital, Copenhagen, Denmark.

Not presented.

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Brief ReportRight atrial and ventricular function evaluated with speckle tracking in patients with acute pulmonary embolism☆,☆☆

Abstract

Aims

Methods and Results

Conclusion

Introduction

Section snippets

Patients and protocol

Results

Discussion

J Am Soc Echocardiogr

Am J Cardiol

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Soc Echocardiogr

Brief Report
Right atrial and ventricular function evaluated with speckle tracking in patients with acute pulmonary embolism☆,☆☆