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Prognostic value of echocardiographic parameters for right ventricular function in patients with acute non-massive pulmonary embolism

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Abstract

A prognostic value of right ventricular (RV) systolic function assessed by echocardiography in patients with acute non-massive pulmonary embolism (PE) remains controversial. The hypothesis was RV free wall strain measured using speckle-tracking echocardiography might be a powerful prognostic factor in those patients. We aimed to evaluate the prognostic value of echocardiographic measurements of RV systolic function for clinical outcomes and to assess the correlation between the echocardiographic RV function parameters in patients with acute non-massive PE. Between November 2013 and September 2016, 144 consecutive patients diagnosed as acute non-massive pulmonary embolism were prospectively enrolled and echocardiographic evaluations were performed within 1 week of diagnosis to measure various parameters of RV systolic function. The primary endpoint was in-hospital events, the composite of in-hospital PE-related death, need of additive treatments such as thrombolysis or pulmonary artery thromboembolectomy, and need of inotropics due to unstable vital sign. Among patients (mean age 60.3 ± 14.7 years, 50% female) with acute non-massive PE, the in-hospital event rate was 11.1% (16 of 144 patients). In multivariate logistic regression analysis, after adjustment of confounding factors such as age, gender, and diabetes mellitus, RV free wall strain [odd ratio (OR) 1.12, 95% confidence interval (CI) 1.04–1.21, p = 0.002] and RV global wall strain (OR 1.20, 95% CI 1.07–1.35, p = 0.002) were independent predictors for in-hospital events. The event rates were significantly different between groups classified based on RV free wall strain with cut-off value of − 15.85% (p < 0.001). RV strain assessed with speckle-tracking echocardiography is an independent prognostic marker for in-hospital events in patients with acute non-massive PE. Our results may help identify high–intermediate risk patients who need a closer monitoring.

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References

  1. Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, Jenkins JS, Kline JA, Michaels AD, Thistlethwaite P, Vedantham S, White RJ, Zierler BK, American Heart Association Council on Cardiopulmonary CCP, Resuscitation, American Heart Association Council on Peripheral Vascular D, American Heart Association Council on Arteriosclerosis T, Vascular B (2011) Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation 123:1788–1830

    Article  PubMed  Google Scholar 

  2. Goldhaber SZ, Visani L, De Rosa M (1999) Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 353:1386–1389

    Article  CAS  PubMed  Google Scholar 

  3. Kreit JW (2004) The impact of right ventricular dysfunction on the prognosis and therapy of normotensive patients with pulmonary embolism. Chest 125:1539–1545

    Article  PubMed  Google Scholar 

  4. Chung T, Emmett L, Mansberg R, Peters M, Kritharides L (2007) Natural history of right ventricular dysfunction after acute pulmonary embolism. J Am Soc Echocardiogr 20:885–894

    Article  PubMed  Google Scholar 

  5. Hariharan P, Dudzinski DM, Rosovsky R, Haddad F, MacMahon P, Parry B, Chang Y, Kabrhel C (2016) Relation among clot burden, right-sided heart strain, and adverse events after acute pulmonary embolism. Am J Cardiol 118:1568–1573

    Article  PubMed  Google Scholar 

  6. Kucher N, Rossi E, De Rosa M, Goldhaber SZ (2005) Prognostic role of echocardiography among patients with acute pulmonary embolism and a systolic arterial pressure of 90 mm Hg or higher. Arch Intern Med 165:1777–1781

    Article  PubMed  Google Scholar 

  7. Grifoni S, Olivotto I, Cecchini P, Pieralli F, Camaiti A, Santoro G, Conti A, Agnelli G, Berni G (2000) Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation 101:2817–2822

    Article  CAS  PubMed  Google Scholar 

  8. Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galie N, Gibbs JS, Huisman MV, Humbert M, Kucher N, Lang I, Lankeit M, Lekakis J, Maack C, Mayer E, Meneveau N, Perrier A, Pruszczyk P, Rasmussen LH, Schindler TH, Svitil P, Vonk Noordegraaf A, Zamorano JL, Zompatori M, Task Force for the D, Management of Acute Pulmonary Embolism of the European Society of C (2014) 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 35:3033-3069 (3069a–3069k)

    Article  CAS  Google Scholar 

  9. Coutance G, Cauderlier E, Ehtisham J, Hamon M, Hamon M (2011) The prognostic value of markers of right ventricular dysfunction in pulmonary embolism: a meta-analysis. Crit Care 15:R103

    Article  PubMed  PubMed Central  Google Scholar 

  10. Sanchez O, Trinquart L, Colombet I, Durieux P, Huisman MV, Chatellier G, Meyer G (2008) Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: a systematic review. Eur Heart J 29:1569–1577

    Article  PubMed  Google Scholar 

  11. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23:685–713 (quiz 786–788)

    Article  Google Scholar 

  12. Tei C, Dujardin KS, Hodge DO, Bailey KR, McGoon MD, Tajik AJ, Seward SB (1996) Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr 9:838–847

    Article  CAS  Google Scholar 

  13. Topilsky Y, Khanna AD, Oh JK, Nishimura RA, Enriquez-Sarano M, Jeon YB, Sundt TM, Schaff HV, Park SJ (2011) Preoperative factors associated with adverse outcome after tricuspid valve replacement. Circulation 123:1929–1939

    Article  PubMed  Google Scholar 

  14. Abbas AE, Fortuin FD, Schiller NB, Appleton CP, Moreno CA, Lester SJ (2003) A simple method for noninvasive estimation of pulmonary vascular resistance. J Am Coll Cardiol 41:1021–1027

    Article  PubMed  Google Scholar 

  15. Vitarelli A, Barilla F, Capotosto L, D'Angeli I, Truscelli G, De Maio M, Ashurov R (2014) Right ventricular function in acute pulmonary embolism: a combined assessment by three-dimensional and speckle-tracking echocardiography. J Am Soc Echocardiogr 27:329–338

    Article  PubMed  Google Scholar 

  16. Dahhan T, Siddiqui I, Tapson VF, Velazquez EJ, Sun S, Davenport CA, Samad Z, Rajagopal S (2016) Clinical and echocardiographic predictors of mortality in acute pulmonary embolism. Cardiovasc Ultrasound 14:44

    Article  PubMed  PubMed Central  Google Scholar 

  17. Haddad F, Guihaire J, Skhiri M, Denault AY, Mercier O, Al-Halabi S, Vrtovec B, Fadel E, Zamanian RT, Schnittger I (2014) Septal curvature is marker of hemodynamic, anatomical, and electromechanical ventricular interdependence in patients with pulmonary arterial hypertension. Echocardiography 31:699–707

    Article  PubMed  Google Scholar 

  18. Risum N, Jons C, Olsen NT, Fritz-Hansen T, Bruun NE, Hojgaard MV, Valeur N, Kronborg MB, Kisslo J, Sogaard P (2012) Simple regional strain pattern analysis to predict response to cardiac resynchronization therapy: rationale, initial results, and advantages. Am Heart J 163:697–704

    Article  PubMed  Google Scholar 

  19. Khemasuwan D, Yingchoncharoen T, Tunsupon P, Kusunose K, Moghekar A, Klein A, Tonelli AR (2015) Right ventricular echocardiographic parameters are associated with mortality after acute pulmonary embolism. J Am Soc Echocardiogr 28:355–362

    Article  PubMed  Google Scholar 

  20. Wan S, Quinlan DJ, Agnelli G, Eikelboom JW (2004) Thrombolysis compared with heparin for the initial treatment of pulmonary embolism: a meta-analysis of the randomized controlled trials. Circulation 110:744–749

    Article  CAS  PubMed  Google Scholar 

  21. Grifoni S, Vanni S, Magazzini S, Olivotto I, Conti A, Zanobetti M, Polidori G, Pieralli F, Peiman N, Becattini C, Agnelli G (2006) Association of persistent right ventricular dysfunction at hospital discharge after acute pulmonary embolism with recurrent thromboembolic events. Arch Intern Med 166:2151–2156

    Article  PubMed  Google Scholar 

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Funding

This study was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF-2015R1A2A2A03003552) and a Grant (2015-7009) from the Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea.

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Authors and Affiliations

  1. Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Kyusup Lee, Osung Kwon, Eun-Jeong Lee, Min-Jung Sin, Sahmin Lee, Duk-Hyun Kang, Jae-Kwan Song & Jong-Min Song

  2. Division of Pulmonology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Jae Seung Lee

  3. Pulmonary Hypertension and Venous Thrombosis Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Jae Seung Lee & Jong-Min Song

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  1. Kyusup Lee
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Lee, K., Kwon, O., Lee, EJ. et al. Prognostic value of echocardiographic parameters for right ventricular function in patients with acute non-massive pulmonary embolism. Heart Vessels 34, 1187–1195 (2019). https://doi.org/10.1007/s00380-019-01340-1

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