Brief ReportRight atrial and ventricular function evaluated with speckle tracking in patients with acute pulmonary embolism☆,☆☆
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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Cited by (18)
What echocardiographic findings differentiate acute pulmonary embolism and chronic pulmonary hypertension?
2023, American Journal of Emergency MedicineWhat are the echocardiographic findings of acute right ventricular strain that suggest pulmonary embolism?
2021, Anaesthesia Critical Care and Pain MedicineCitation Excerpt :Currently, the ASE and EACVI posit a mean percentage of right ventricular free wall strain as -29% ± 4.5%, with an abnormality threshold being > −20% (or < 20% in magnitude) [10]. Both global longitudinal strain and strain of individual right ventricular segments are reduced in patients with PE [76,110,120–124]. Studies have also demonstrated lesser strain in the mid-right ventricular free wall as compared to the basal and apical segments, in a pattern similar to McConnell’s sign [125,126].
Ventricular systolic dysfunction with and without altered myocardial contractility: Clinical value of echocardiography for diagnosis and therapeutic decision-making
2021, International Journal of CardiologyCitation Excerpt :RV systolic function correlates with prognosis across a wide spectrum of cardiovascular and cardio-respiratory pathology and ECHO facilitates individual risk stratification and selection of appropriate therapies [91,126,127]. Although the high load dependency of systolic parameters complicates the in-corporation of RV systolic dysfunction into clinical decision-making, due to the high sensitivity of the RV to increased PVR, surveillance of RV size and function can provide essential information for the distinction between primary (myocardial damage-induced) and secondary (afterload mismatch-induced) RV dysfunction [16,91,102,126–132]. This issue has recently become particularly important after detection that small pulmonary vessel thrombosis associated with pulmonary blood flow alterations followed by right heart dilation and RVF are often the major cause of death related to COVID-19 [133–137].
Right atrial function with speckle tracking echocardiography: Do we really need it?
2017, Revista Portuguesa de CardiologiaMonitoring of the right ventricular responses to pressure overload: prognostic value and usefulness of echocardiography for clinical decision-making
2024, Cardiovascular Diagnosis and Therapy
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Funding/Support: None.
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Institution where work was done: Department of Cardiology, Amager Hospital, Copenhagen, Denmark.
Not presented.