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Regional right ventricular dysfunction in acute pulmonary embolism: relationship with clot burden and biomarker profile

  • Mirela Tuzovic
  • Sasikanth Adigopula
  • Myriam AmsallemEmail author
  • Yukari Kobayashi
  • Michael Kadoch
  • David Boulate
  • Gomathi Krishnan
  • David Liang
  • Ingela Schnittger
  • Dominik Fleischmann
  • Michael V. McConnell
  • François Haddad
Original Paper

Abstract

Regional right ventricular (RV) dysfunction (RRVD) is an echocardiographic feature in acute pulmonary embolism (PE), primarily reported in patients with moderate-to-severe RV dysfunction. This study investigated the clinical importance of RRVD by assessing its relationship with clot burden and biomarkers. We identified consecutive patients admitted to the emergency department between 1999 and 2014 who underwent computed tomographic angiography, echocardiography, and biomarker testing (troponin and NT-proBNP) for suspected acute PE. RRVD was defined as normal excursion of the apex contrasting with hypokinesis of the mid-free wall segment. RV assessment included measurements of ventricular dimensions, fractional area change, free-wall longitudinal strain and tricuspid annular plane systolic excursion. Clot burden was assessed using the modified Miller score. Of 82 patients identified, 51 had acute PE (mean age 66 ± 17 years, 43 % male). No patient had RV myocardial infarction. RRVD was present in 41 % of PEs and absent in all patients without PE. Among patients with PE, 86 % of patients with RRVD had central or multi-lobar PE. Patients with RRVD had higher prevalence of moderate-to-severe RV dilation (81 vs. 30 %, p < 0.01) and dysfunction (86 vs. 23 %, p < 0.01). There was a strong trend for higher troponin level in PE patients with RRVD (38 vs. 13 % in PE patients without RRVD, p = 0.08), while there was no significant difference for NT-proBNP (67 vs. 73 %, p = 0.88). RRVD showed good concordance between readers (87 %). RRVD is associated with an increased clot burden in acute PE and is more prevalent among patients with moderate-to-severe RV enlargement and dysfunction.

Keywords

Echocardiography Regional right ventricular dysfunction McConnell sign Pulmonary embolism 

Notes

Acknowledgments

M.A. received a research fellowship from the Fédération Française de Cardiologie. M.V.M. receives MRI research support from GE Healthcare. None of the other authors have any conflicts of interest relative to the study.

Compliance with ethical standards

This research involves human participants. All participants gave their informed consent before inclusion.

Conflict of interest

None of the authors have any conflicts of interest.

Supplementary material

10554_2015_780_MOESM1_ESM.tif (969 kb)
Figure S1: Inter-observer agreement of the regional RV dysfunction between level 3 and level 2 readers. (+): Regional RV dysfunction (RRVD) classified as present/(−): RRVD classified as absent. L2 represents level 2 reader and L3 level 3. (TIFF 968 kb)

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Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Mirela Tuzovic
    • 1
    • 5
  • Sasikanth Adigopula
    • 1
    • 5
  • Myriam Amsallem
    • 1
    • 5
    Email author
  • Yukari Kobayashi
    • 1
    • 5
  • Michael Kadoch
    • 3
  • David Boulate
    • 2
  • Gomathi Krishnan
    • 4
  • David Liang
    • 1
    • 5
  • Ingela Schnittger
    • 1
    • 5
  • Dominik Fleischmann
    • 3
  • Michael V. McConnell
    • 1
    • 5
  • François Haddad
    • 1
    • 5
  1. 1.Division of Cardiovascular MedicineStanford University School of MedicineStanfordUSA
  2. 2.Unité de Recherche Clinique, Marie Lannelongue HospitalUniversity of Paris XILe Plessis RobinsonFrance
  3. 3.Division of RadiologyStanford University School of MedicineStanfordUSA
  4. 4.Center for Clinical InformaticsStanford University Medical CenterPalo AltoUSA
  5. 5.Stanford Cardiovascular InstituteStanford University School of MedicinePalo AltoUSA

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