6 research outputs found
Right ventricular function in pulmonary embolism
Patients with pulmonary embolism (PE) and right ventricular (RV) dysfunction are known to be
at risk of in-hospital clinical worsening and PE-related mortality. Even in patients with a
preserved systemic arterial pressure, the RV dysfunction indicates a higher risk, thus affecting
the patients’ level of care and the therapeutic approach. Involvement of the right ventricle is
usually associated with at least a moderate degree of PE. The extent of the pulmonary vascular
obstruction has been shown to be crucial for the increase in pulmonary vascular resistance and,
thereby, for the prognosis of the patients. A substantially elevated D-dimer in clinically
suspected patients is suggestive of PE and is associated with an adverse outcome.
Echocardiography is frequently used to assess RV function in PE patients. The pulsed-wave
Doppler tissue imagining (DTI) technique has been used to detect RV dysfunction in different
clinical conditions and has been validated by several non-invasive techniques. The aim of these
studies was to investigate the role of RV dysfunction detected by echocardiographic techniques
in PE patients and to relate the findings to D-dimer levels, the extent of perfusion loss detected
by pulmonary scintigraphy, and clinical prediction rules.
Study I: By using tricuspid annular plane excursion, both systolic and diastolic RV functions
were found to be impaired in the acute stage and, to an even higher degree, in association with
an elevated RV systolic pressure. Diastolic function recovered earlier than systolic function.
Study II: Using DTI technique, disturbed diastolic RV function was identified in patients with
normal RV systolic pressure, normal RV systolic function and normal filling pressure.
Study III: A cut-off value for the D-dimer level was found to identify patients with RV
dysfunction. Patients with higher D-dimer levels also had higher pulmonary vascular resistance
and RV systolic pressure.
Study IV: Signs of RV dysfunction were detected even in patients with relatively small lung
perfusion losses. Lung perfusion had good correlation with pulmonary vascular resistance.
Conclusion: Non-high-risk PE patients show signs of disturbed RV function. Diastolic RV
function seems to be affected earlier than systolic RV function, as detected by the DTI-derived
tricuspid early diastolic velocity (Em), indicating that this parameter can be used to detect RV
dysfunction even in patients with normal systolic RV pressure at presentation. Also, a certain Ddimer
level and degree of lung perfusion loss may be useful in identifying non-high-risk PE
patients who should be further investigated and monitored