To evaluate short-term prognosis of normotensive patients with pulmonary embolism diagnosed by spiral CT and RV dysfunction by echocardiogram. Prognostic value of RV dysfunction in this group of patients is not fully evaluated.
Retrospective medical record analysis was performed in patients with documented PE and echocardiogram. Total of 21 patients met the inclusion criteria. Patient’s data include symptoms, vital signs, clinical history, ABG’s, EKG, CXR and spiral CT. Echocardiograms were reviewed by a cardiologist. Patients with one or more of the following criteria were considered to have acute RV dysfunction (1) RV dilatation (RVEDD>30 mm or RV/LV end-diastolic diameter ratio >1 in four-chamber view) (2) septal flattening and paradoxical septal motion (3) McConnell’s sign (normokinesis or hyperkinesis of RV apex with right ventricular free wall hypokinesis) (4) pulmonary arterial hypertension detected with tricuspid regurgitation jet (5) RVOT acceleration time value of <60 msecs in presence of TR pressure gradient <60 mmHg (60/60 sign) (6) Patent foramen ovale (7) direct visualization of thrombus.
RV/LV end-diastolic diameter ratio >1 in four-chamber view positive in 18 patients (85.7%), septal flattening and paradoxical motion positive in 17 patients (80.9%) and McConnell’s sign positive in 15 patients (71.4%). Average pulmonary arterial pressure 53.1 mmHg and average RVEDD 4.6 cm. Patent foramen ovale was found in 3 patients (14.2%), thrombus was visualized in 3 patients (14.2%) and 60/60 sign positive in 1 patient (4.7%). 17 patients received heparin or enoxaparin with wafarin, 2 patients received heparin with IVC filter and 2 patients received heparin, wafarin and IVC filter. There were 4 deaths in the group who met at least five echocardiographic criteria.
Among echocardiographic criteria, RV/LV end-diastolic diameter ratio >1 in four chamber view, septal flattening, paradoxical motion and McConnell’s sign were seen in more than 70% of the patients. The normotensive patient with five or more criteria probably should receive thrombolytic therapy or other intervention.
Echocardiography may play a significant role in making therapeutic decision in normotensive pulmonary embolism patients.
T. Yein, None.