Diagnostic performance of conventional right ventricular function echocardiography parameters in acute pulmonary embolism. Comparison with 3D ejection fraction and longitudinal strain

Abstract

Abstract Background Assessment of right ventricular (RV) function by transthoracic echocardiography (TTE) in acute pulmonary embolism (PE) has an essential role to stratify the severity. However, there is no individual TTE parameter that seems to provide reliable information on RV function. Purpose The objective is to compare the usefulness of advanced echocardiographic parameters, 3D RV ejection fraction (3DEF) and free wall 2D TTE speckle-tracking (2D-ST), in comparison to conventional ones in the RV dysfunction evaluation in patients with acute PE. Methods We prospectively recruited 86 patients with intermediate-high and high-risk bilateral PE from 2018 to 2020 in our centre. TTE during admission included 3DRVEF and 2D-ST and conventional parameters (pulsed tissue Doppler S wave (S'), TAPSE, and fractional area change (FAC)). Normal values were stablished according to European guidelines. Results Mean age was 63.7±16.5 years, 58% males. Reperfusion treatment was performed in a 26.8%. Characteristics at admission and ETT parameters are shown on Table1. The proportion of patients with RV dysfunction evaluated by conventional parameters (42.9% by CAF, 20.8% by TAPSE and 17.7% by S') was lower than using 3DEF and ST (74.5% and 66,7% respectively). Correlation amongst parameters is depicted in table2. FAC had the best correlation with 3DEF and FWLS (p&amp;lt;0.001). If considering 3DEF as “gold standard” in this cohort, FAC had the best performance to detect RV systolic dysfunction with a sensitivity and specificity of 45.9% and 93.2%, respectively, and a positive predictive value of 94.4%. TAPSE and S' had sensitivity of 21.6% and 17.1% respectively and 100% specificity. FWLS had 84.2% and 84.6% of sensitivity and specificity with a positive and negative predictive value of 94.1% and 64.7% respectively. Conclusion Advanced RV function assessmentby 3DEF and 2D-ST can help to identify a greater number of patients with RV dysfunction in high and intermediate-high risk acute PE compared with conventional parameters. FAC seems to be the best option to asses RV systolic function if 3D echo is not available. Funding Acknowledgement Type of funding sources: None. Table 1Table 2 </jats:sec