Pulmonary Vascular Disease: Pulmonary Vascular Disease - PE/DVT |

Right Ventricular Strain in Intermediate to High-Risk Pulmonary Embolism FREE TO VIEW

Lillian Benck, MD; Daniel Schimmel, MD; Jyothy Puthumana, MD; Benjamin Freed, MD; Nicholas Furiasse, MD
Author and Funding Information

Northwestern University, Chicago, IL

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1192A. doi:10.1016/j.chest.2016.08.1301
Text Size: A A A
Published online

SESSION TITLE: Pulmonary Vascular Disease - PE/DVT

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Echocardiographic assessment of right ventricular (RV) function is frequently used in the assessment of patients with acute pulmonary embolism (PE). RV dysfunction associated with PE is independently associated with increased risk of adverse events including death. 2-dimensional right ventricular strain (RVS) may add prognostic information to traditional echocardiographic parameters of RV size and function. We sought to describe RVS pattern in individuals presenting with intermediate to high-risk PE, compare to those who received catheter directed thrombolysis (CDT), and analyze the post-treatment RVS pattern.

METHODS: We reviewed 98 consecutive cases of intermediate to high- risk PE for whom a TTE was completed within 72 hours of diagnosis at a single tertiary care academic institution. Intermediate and high risk PE were defined by European Society of Cardiology 2014 guidelines on PE. Analysis of RVS was performed on all patients at frame rates of at least 40 fps on the Epsilon ™processing system. Global longitudinal (GLS) and free wall strain values were reported for the RV. Analysis of RVS of post-CDT was also performed with median time to follow up TTE of 2.5 days. A total of 67 participants were included in the final analysis

RESULTS: A total of 17 (25%) underwent CDT for treatment of PE. By TTE, 17 patients (25%) had severe RV systolic dysfunction and 20 (30%) had severe RV dilation. McConnell’s sign was present in 43% of subjects. Mean pulmonary artery systolic pressure (PASP) was 43.1. Mean RV basal dilation was 3.9. Mean fractional area of change (FAC) was 25.5. For strain analysis, average GLS was -10.46. Regional strain values were similar. In the CDT subgroup (n = 17) compared to the overall population, mean BNP (745 vs 449, p = 0.07) and PASP (55.67 vs 39.6, p = 0.001) were significantly higher in the pre-treatment thrombolytic group. TAPSE, S’ and fractional area of change were not significantly different. GLS and free wall strain trended worse in the CDT group but also were not statistically different. In the subgroup that received CDT, median time to follow-up TTE was 2.5 days. Following CDT, severe RV systolic dysfunction decreased from 41% to 12%, McConnell’s reporting decreased from 65% to 18% and PASP decreased from 56.4 mmHg to 49 mmHg (p = 0.17). There was no change in GLS (-11.2 vs -11.1) or RV free wall strain (-12.99 vs -13).

CONCLUSIONS: In intermediate to high-risk pulmonary embolism, strain measurements appear to correlate with abnormalities in traditional echocardiographic measurements of right ventricular dysfunction. Howevere, while classic measurements of RV function and size improved with treatment, strain measurements did not show improvement in the early post-treatment evaluation.

CLINICAL IMPLICATIONS: Strain analysis allows for quantitative measurement of global and regional myocardial wall motion and may add important information about right ventricular function in individuals with acute pulmonary embolism. Our findings suggest that in intermediate to high-risk pulmonary embolism, right ventricular strain abnormalities may persist despite improvements in other measurements of RV function. Further studies are needed to understand how persistence of strain abnormalities impacts clinical outcomes.

DISCLOSURE: The following authors have nothing to disclose: Lillian Benck, Daniel Schimmel, Jyothy Puthumana, Benjamin Freed, Nicholas Furiasse

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543