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

Mirela Tuzovic, Sasikanth Adigopula, Myriam Amsallem, Yukari Kobayashi, Michael A Kadoch, David Boulate, Gomathi Krishnan, David Liang, Ingela Schnittger, Dominik Fleischmann, Michael V. McConnell, François Haddad

Research output: Contribution to journalArticle

7 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)389-398
Number of pages10
JournalInternational Journal of Cardiovascular Imaging
Volume32
Issue number3
DOIs
StatePublished - Mar 1 2016
Externally publishedYes

Fingerprint

Right Ventricular Dysfunction
Pulmonary Embolism
Biomarkers
Troponin
Patient Rights
Echocardiography
Hospital Emergency Service
Dilatation
Angiography
Myocardial Infarction

Keywords

  • Echocardiography
  • McConnell sign
  • Pulmonary embolism
  • Regional right ventricular dysfunction

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Regional right ventricular dysfunction in acute pulmonary embolism : relationship with clot burden and biomarker profile. / Tuzovic, Mirela; Adigopula, Sasikanth; Amsallem, Myriam; Kobayashi, Yukari; Kadoch, Michael A; Boulate, David; Krishnan, Gomathi; Liang, David; Schnittger, Ingela; Fleischmann, Dominik; McConnell, Michael V.; Haddad, François.

In: International Journal of Cardiovascular Imaging, Vol. 32, No. 3, 01.03.2016, p. 389-398.

Research output: Contribution to journalArticle

Tuzovic, M, Adigopula, S, Amsallem, M, Kobayashi, Y, Kadoch, MA, Boulate, D, Krishnan, G, Liang, D, Schnittger, I, Fleischmann, D, McConnell, MV & Haddad, F 2016, 'Regional right ventricular dysfunction in acute pulmonary embolism: relationship with clot burden and biomarker profile', International Journal of Cardiovascular Imaging, vol. 32, no. 3, pp. 389-398. https://doi.org/10.1007/s10554-015-0780-1
Tuzovic, Mirela ; Adigopula, Sasikanth ; Amsallem, Myriam ; Kobayashi, Yukari ; Kadoch, Michael A ; Boulate, David ; Krishnan, Gomathi ; Liang, David ; Schnittger, Ingela ; Fleischmann, Dominik ; McConnell, Michael V. ; Haddad, François. / Regional right ventricular dysfunction in acute pulmonary embolism : relationship with clot burden and biomarker profile. In: International Journal of Cardiovascular Imaging. 2016 ; Vol. 32, No. 3. pp. 389-398.
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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.",
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AU - Kadoch, Michael A

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