A novel echocardiographic parameter for assessment of right ventricular function in acute pulmonary embolism: an experimental study

2019 ◽  
Author(s):  
Decai Zeng ◽  
Ji Wu ◽  
Hui Chen ◽  
Ying Tan ◽  
Xueyu Che ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Acute Pulmonary Embolism ◽  
Autologous Blood ◽  
Left Ventricular ◽  
Control Group ◽  
Tei Index ◽  
Significant Difference ◽  
Acute Pe ◽  
Rv Function

Abstract Background Right ventricular (RV) dysfunction played a decisive role in clinical management and associated with poor prognosis in acute pulmonary embolism (PE). It still remains challenging to estimate RV function accurately for the reason of complex structure and geometry. The present study aimed to determine the value of right ventricular outflow tract systolic excursion (RVOT-SE) in evaluating RV function in an animal model with acute PE. Methods Thirty-three healthy New Zealand rabbits were randomly assigned to massive thrombus group, sub-massive thrombus group and control group, 11 rabbits per group. The acute PE model was established by intravenous infusion of autologous blood clots. After 1h of thrombus injection, transthoracic echocardiography was performed to assess RV function in all rabbits. Results The acute PE model was successfully made in 18 rabbits (massive thrombus group, n = 8; sub-massive thrombus group n = 10). Right/left ventricular end-diastolic diameter (RV/LV) ratio and RV myocardial performance (Tei) index were significantly increased, while RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE) and RVOT_SE were reduced in massive thrombus group. The value of RVOT-SE and RVFAC in sub-massive thrombus group decreased significantly compared with control group (P < 0.05). But there was no significant difference in RV/LV, TAPSE and Tei index (P > 0.05). ROC analysis showed that RVOT-SE had high sensitivity (94.4%) and specificity (72.7%) in identifying RV dysfunction in acute PE. The area under the ROC curve (AUC) for combined TAPSE and RVOT-SE was greater than that of TAPSE or RVOT-SE alone (AUC= 0.962, P < 0.01). Conclusion RV function in acute PE is significantly decreased, which is closely related to the size of embolus. RVOT_SE is a simple and highly distinctive parameter in identifying RV dysfunction and tends to be superior to conventional parameters in acute PE. The combination of RVOT-SE and TAPSE can further improve the diagnostic accuracy of acute PE.

Increased Brain Natriuretic Peptide as a Marker for Right Ventricular Dysfunction in Acute Pulmonary Embolism

2001 ◽  
Vol 86 (11) ◽  
pp. 1193-1196 ◽  
Author(s):  
Igor Tulevski ◽  
Alexander Hirsch ◽  
Bernd-Jan Sanson ◽  
Hans Romkes ◽  
Ernst van der Wall ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Brain Natriuretic Peptide ◽  
Right Ventricular ◽  
Natriuretic Peptide ◽  
Acute Pulmonary Embolism ◽  
Prognostic Significance ◽  
Systolic Pressure ◽  
Clinical Importance ◽  
Acute Pe ◽  
Rv Function

SummaryRight ventricular (RV) function is of major prognostic significance in patients with acute pulmonary embolism (PE). The aim of the present study was to evaluate the role of neurohormone plasma brain natriuretic peptide (BNP) in assessing RV function in patients with acute PE.BNP levels were measured in 16 consecutive patients with acute PE as diagnosed by high probability lung scintigraphy or pulmonary angiography. Twelve healthy age-matched volunteers served as controls. All 16 patients underwent standard echocardiography and blood tests during the first hour of presentation. In the patient group, survival was studied for a period of 30 days. Plasma BNP levels in patients with acute PE were higher than in controls (7.2 [95% CI 0.4 to 144.6] versus 1.4[95% CI 0.4 to 4.6] pmol/L, p = 0.0008). Plasma BNP was significantly higher in 5 patients with RV dysfunction compared to 11 patients with normal RV function (40.2 [95% CI 7.5 to 214.9] versus 3.3 [95% CI 0.4 to 24.9] pmol/L, p = 0.0003). RV systolic pressure was not significantly correlated with BNP (r = 0.42, p = ns).In conclusion, plasma BNP neurohormone levels might be of clinical importance as a supplementary tool for assessment of RV function in patients with acute PE.

scholarly journals Levosimendan, milrinone and dobutamine in acute experimental pulmonary embolism

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
MD Lyhne ◽  
SJ Dragsbaek ◽  
JV Hansen ◽  
JG Schultz ◽  
A Andersen ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Cardiovascular Effects ◽  
Right Heart Catheterization ◽  
Mechanical Work ◽  
Heart Catheterization ◽  
Funding Sources ◽  
Mean Pulmonary Arterial Pressure ◽  
Acute Pe ◽  
Rv Function

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Laerdal Foundation for Acute Medicine, Novo Nordisk Foundation Background/Introduction: Acute pulmonary embolism (PE) is a frequent condition in acute cardiac care and is potentially fatal. Cause of death is right ventricular (RV) failure due to increased RV afterload from both pulmonary vascular obstruction and vasoconstriction. Inodilators are interesting drugs of choice as they may improve RV function and lower its afterload. Purpose We aimed to investigate the cardiovascular effects of three clinically relevant inodilators: levosimendan, milrinone and dobutamine in acute PE. Methods We conducted a randomized, blinded, animal study using 18 female pigs. Animals received large autologous PE until doubling of baseline mean pulmonary arterial pressure and were randomized to four logarithmically increasing doses of each inodilator. Effects were evaluated with bi-ventricular pressure-volume loop recordings, right heart catheterization and blood gas analyses. Results Induction of PE increased RV afterload and pulmonary pressure (p &lt; 0.05) causing RV dysfunction. Levosimendan and milrinone showed beneficial hemodynamic profiles by lowering RV pressures and volume (p &lt; 0.001) and improved RV function and cardiac output (p &lt; 0.05) without increasing RV mechanical work. Dobutamine increased RV pressure and function (p &lt; 0.01) but at a cost of increased mechanical work at the highest doses, showing an adverse hemodynamic profile. See Figure. Conclusion(s): In a porcine model of acute PE, levosimendan and milrinone reduced RV afterload and improved RV function, whereas dobutamine at higher doses increased RV afterload and RV mechanical work. The study motivates clinical testing of inodilators in patients with acute PE and RV dysfunction. Abstract Figure. Inodilators in acute pulmonary embolism

scholarly journals 1187 Evaluation of left and right ventricular functions with 3D speckle tracking in patients with mitral stenosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
O Seckin ◽  
S Unlu ◽  
G Tacoy
Keyword(s):  
Right Ventricular ◽  
Mitral Stenosis ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Three Dimensional ◽  
Left Ventricular ◽  
Control Group ◽  
Free Wall ◽  
Significant Difference

Abstract Background The function of both ventricles have been suggested to be affected in patients with mitral stenosis. In this study, it was aimed to investigate deformation properties of right (RV) and left ventricles (LV) in mild and moderate rheumatic mitral stenosis (MS) patients with three-dimensional speckle tracking echocardiography (3D-STE). Methods A total of 60 patients were included in the study (20 patients with mild MS diagnosis, 20 patients with moderate MS diagnosis and 20 healthy volunteers). Three-dimensional echocardiography datasets were obtained for both ventricles in all patients. An example for RV assessment is shown in Figure 1. LV global longitudinal strain (GLS), LV torsion, RV free wall (FW) LS and interventricular septal (IVS) LS measurements were analyzed. Results The LV ejection fraction (EF), RV fractional area change and tricuspid annular plane systolic excursion values were statistically similar and in the normal range. The LV GLS measurements were significantly different among the groups by being highest in the control group and least in the moderate stenosis group (ANOVA,p &lt; 0.001) (Table 1). Patients with MS showed higher torsional values, correlated with MS severity (ANOVA,p &lt; 0.001) (Table 1). IVS LS, RVFW LS values obtained by RV analysis also differed significantly among groups. The FW-GLS values only showed significant difference between the control group and moderate MS group (Table 1). Conclusion Patients with mitral stenosis showed lower LV-GLS and higher LV torsion values. Although the LV GLS is affected; the LV EF was detected to be normal due to increase in LV torsion. RV deformation indices showed signıficant decrease in correlation with the severity of the mitral stenosis. In conclusion, our data suggest that subclinical LV and RV systolic dysfunction is present in mild-moderate MS patients and this dysfunction can be detected by 3D-STE. Table 1 Parameters Control group Mild MS Moderate MS P LV GLS (%) 23.3 ± 2.08 18.9 ± 1.3 17.5 ± 1.8 &lt;0.001 LV torsion 1.5 ± 0.6 2.1 ± 0.6 2.6 ± 0.5 &lt;0.001 IVS LS (%) 23 ± 3.0% 20 ± 2.6 17.1 ± 2.9 &lt;0.001 RV FW LS (%) 25.4 ± 5 22.7 ± 3.2 21.1 ± 4.8 &lt;0.001 FW; free-wall, GLS; global longitudinal strain, IVS; interventricular septum, LV; left ventricular, RV; right ventricular Abstract 1187 Figure 1

scholarly journals Right-to-left Ventricular Diameter Ratio At Computed Tomographic Pulmonary Angiography in Patients with Acute Pulmonary Embolism and Obstructive Sleep Apnea

2020 ◽  
Vol 14 ◽  
pp. 117954842097643
Author(s):  
Thomas M Berghaus ◽  
Fabian Geissenberger ◽  
Dinah Konnerth ◽  
Michael Probst ◽  
Thomas Kröncke ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Obstructive Sleep Apnea ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Angiography ◽  
Left Ventricular ◽  
Diameter Ratio ◽  
Computed Tomographic ◽  
Obstructive Sleep ◽  
Computed Tomographic Pulmonary Angiography ◽  
Acute Pe

Purpose: Right ventricular (RV) dysfunction in acute pulmonary embolism (PE) is a critical determinant of outcome. Obstructive sleep apnea (OSA) is a common comorbidity of PE and might also affect RV function. Therefore, we sought to investigate RV dysfunction in PE patients in proportion to the severity of OSA by evaluating the right-to-left ventricular (RV/LV) diameter ratio on computed tomographic pulmonary angiography (CTPA). Materials and Methods: 197 PE patients were evaluated for sleep-disordered breathing by portable monitoring and nocturnal polysomnography. RV dilatation was defined as an RV/LV diameter ratio of ⩾ 1.0. Results: RV dilatation was significantly more frequent in OSA patients compared to study participants without OSA (66.4% vs 49.1%, P = .036). Elevated troponin I values, indicating myocardial injury due to acute, PE-related RV strain, were significantly more frequent in OSA patients with an apnea-hypopnea index (AHI) ⩾ 15/h compared to those with an AHI < 15/h (62.1% vs 45.8%, P = .035). However, RV dysfunction documented by the RV/LV diameter ratio on CTPA was not significantly associated with the severity of OSA in multivariable regression analysis. Conclusion: Patients with moderate or severe OSA might compensate acute, PE-related RV strain better, as they are adapted to repetitive right heart pressure overloads during sleep.

CILP1 as a biomarker for right ventricular maladaptation in pulmonary hypertension

2020 ◽  
pp. 1901192
Author(s):  
Stanislav Keranov ◽  
Oliver Dörr ◽  
Leili Jafari ◽  
Christian Troidl ◽  
Christoph Liebetrau ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Protein Expression ◽  
Right Ventricular ◽  
Predictive Power ◽  
Pressure Overload ◽  
Serum Levels ◽  
Left Ventricular ◽  
Dilative Cardiomyopathy ◽  
Significant Difference ◽  
Rv Function

The aim of our study was to analyse the protein expression of cartilage intermediate layer protein 1 (CILP1) in a mouse model of right ventricular (RV) pressure overload and to evaluate CILP1 as a biomarker of cardiac remodelling and maladaptive RV function in patients with pulmonary hypertension (PH).Pulmonary artery banding was performed in 14 mice; another 9 mice underwent sham surgery. CILP1 protein expression was analysed in all hearts by western blotting and immunostaining. CILP1 serum concentrations were measured in 161 patients (97 with adaptive and maladaptive RV pressure overload caused by PH; 25 with left ventricular (LV) hypertrophy; 20 with dilative cardiomyopathy (DCM); 19 controls without LV or RV abnormalities)In mice, the amount of RV CILP1 was markedly higher after banding than after sham. Control patients had lower CILP1 serum levels than all other groups (p<0.001). CILP1 concentrations were higher in PH patients with maladaptive RV function than those with adaptive RV function (p<0.001), LV pressure overload (p<0.001), and DCM (p=0.003). CILP1 showed good predictive power for maladaptive RV in ROC analysis (AUC 0.79). There was no significant difference between the AUCs of CILP1 and NT-pro-BNP (AUC 0.82). High CILP1 (≥cut-off value for maladaptive RV of 4373 pg·mL−1) was associated with lower TAPSE/PASP ratios (p<0.001) and higher NT-pro-BNP levels (p<0.001).CILP1 is a novel biomarker of RV and LV pathological remodelling that is associated with RV maladaptation and ventriculoarterial uncoupling in patients with PH.

scholarly journals The Association between the Pulmonary Arterial Obstruction Index and Atrial Size in Patients with Acute Pulmonary Embolism

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Taraneh Faghihi Langroudi ◽  
Maryam Sheikh ◽  
Mohammadreza Naderian ◽  
Morteza Sanei Taheri ◽  
Amir Ashraf-ganjouei ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Multidetector Ct ◽  
Control Group ◽  
Chronic Obstructive ◽  
Expert Radiologist ◽  
Atrial Size ◽  
Significant Difference ◽  
Pulmonary Arterial ◽  
Pulmonary Arterial Obstruction

Purpose. Pulmonary embolism (PE) is a common and potentially fatal form of venous thromboembolism. The aim of this study is to investigate the association between the pulmonary arterial obstruction index and atrial size in patients with acute pulmonary embolism. Basic Procedure. The study consisted of 86 patients with clinical symptoms of PE. Out of 86 individuals, 50 patients were diagnosed with PE and considered as the patient group. The others were considered as the control group. All patients were scanned by a multidetector CT scanner. Using the radiology workstation, an expert radiologist calculated the left atrium (LA) and right atrium (RA) areas from planimetric measurements obtained from free-hand delineation of the atrial boarders using an electronic pen. Quantitative volumetric measurements of LA and RA were obtained from original axial images. Main Findings. There were 25 males and 25 females with PE, who had a mean age of 58 years. There was not a significant difference in the positive history of diabetes mellitus, hypertension, asthma, chronic obstructive pulmonary diseases, ischemic heart disease, and smoking between patients and control group. There was a significant negative correlation between almost all LA measurements and the PAOI. RA area and volume had the highest area under the curves for recognizing larger clot burden. Principal Conclusions. A higher clot load is associated with a smaller LA size and increased RA/LA ratios, measured with CTPA. Atrial measurements are correlated with POAI, and they could be used as sensitive parameters in predicting heart failure in patients with PE.

scholarly journals Factors Associated with One-year Mortality in Patients with Acute Pulmonary Embolism

2016 ◽  
Vol 2 (2) ◽  
pp. 63-70 ◽  
Author(s):  
Diana Opincariu ◽  
András Mester ◽  
Mihaela Raţiu ◽  
Nora Rat ◽  
Lehel Bordi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Hemodynamic Instability ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Factors Associated ◽  
One Year ◽  
Acute Pe ◽  
Acute Event

Abstract Introduction: Pulmonary embolism (PE) is the most common cause of vascular death after myocardial infarction and stroke, being associated with high mortality and morbidity rates. The aim of this study was to assess the factors related to 1-year mortality in patients with acute pulmonary embolism who survived the acute event. Material and methods: In total, 104 patients who had survived the acute episode of pulmonary embolism and underwent a one-month follow-up after the acute event were included in the study. The patients were divided into two groups: Group 1 – patients who had survived at one year after being diagnosed with acute PE (80.76%, n = 84), and Group 2 – patients who had died after one year (19.23%, n = 20). Results: There were no differences between the 2 groups in relation to gender (p = 0.3), or cardiovascular risk factors (diabetes: p = 0.5, smoking: p = 0.3, hypertension: p = 1, hypercholesterolemia: p = 0.5, hypertriglyceridemia: p = 0.4). Patients who had deceased were significantly older (73.35 ± 9.37 years vs. 66.36 ± 11.17 years, p = 0.005) and had a higher weight compared to the survivors (85.8 ± 21.09 kg vs. 75.89 ± 22.69 kg, p = 0.03). Left ventricular ejection fraction, measured by cardiac ultrasound, was significantly lower in the deceased group compared to survivors (45.63 ± 8.9% vs. 52.86 ± 6.8%, p = 0.03). Multivariate analysis identified the hemodynamic instability (OR = 3.17, p = 0.007), the presence of left QRS axis deviation (OR = 4.81, p = 0.001), associated pulmonary pathologies (OR = 3.2, p = 0.02) as well as the presence of chronic kidney disease (OR = 5, p = 0.04) as the most powerful predictors of death at 1 year in patients with acute PE surviving the acute event. Conclusions: Factors associated with a higher mortality rate at 1 year in patients who had survived at 1 month following an acute pulmonary embolism episode included: older age, higher body weight, presence of associated pulmonary pathologies, chronic kidney disease, left axis deviation, low left ventricular ejection fraction, hemodynamic instability requiring inotropic support, cardiogenic shock at presentation or cardiac arrest during the acute phase.

scholarly journals Case Report: Successful revascularization in massive pulmonary embolism with a large protruding thrombus and dilated cardiomyopathy

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 13
Author(s):  
Hendri Susilo ◽  
Rerdin Julario ◽  
Citrawati Dyah Kencono Wungu
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Right Ventricular ◽  
Dilated Cardiomyopathy ◽  
Acute Pulmonary Embolism ◽  
Systolic Function ◽  
Vena Cava ◽  
Massive Pulmonary Embolism ◽  
Left Ventricular ◽  
Ventricular Afterload

Pulmonary embolism is a potentially life-threatening condition. Despite advances in diagnostics, lack of consensus and delays in determining the diagnosis of pulmonary embolism are still important problems. We report the diagnosis and management of a 37-year-old man suffering from massive pulmonary embolism, a large protruding thrombus, and dilated cardiomyopathy. Echocardiography showed dilatation of all cardiac chambers, a large protruding thrombus in the right atrium to the inferior vena cava, impaired left and right ventricular systolic function, and global hypokinetic of the left ventricle with eccentric left ventricular hypertrophy. A thoracic computerized tomography scan showed pulmonary embolism with infarction. The patient’s blood pressure was 60/40 mmHg and heart rate was 110 bpm. The patient was diagnosed with high-risk acute pulmonary embolism. We gave him hemodynamic support and reperfusion therapy with a loading dose of 250,000 units of Streptokinase followed by 100,000 units/hour for 24 hours. After revascularization, the patient's hemodynamic condition improved. The diagnosis of acute pulmonary embolism is based on clinical symptoms, hemodynamic changes, or radiological examination. Unstable hemodynamic underlies high-risk stratification. Hypotension or shock results from obstruction of the pulmonary artery which causes increased right ventricular afterload and acute right ventricular dysfunction. Reperfusion with thrombolysis therapy could provide good outcomes in this patient. Prolonged anticoagulation should be given to prevent the recurrence of venous thromboembolism.

scholarly journals Rapid prediction of adverse outcomes for acute normotensive pulmonary embolism: derivation of the Calgary Acute Pulmonary Embolism (CAPE) score

2021 ◽  
pp. 00879-2020
Author(s):  
Kevin Solverson ◽  
Christopher Humphreys ◽  
Zhiying Liang ◽  
Graeme Prosperi-Porta ◽  
James E. Andruchow ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Risk Score ◽  
Acute Pulmonary Embolism ◽  
Primary Outcome ◽  
Wide Spectrum ◽  
External Validation ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
C Statistic ◽  
Acute Pe

BackgroundAcute pulmonary embolism (PE) has a wide spectrum of outcomes but the best method to risk stratify normotensive patients for adverse outcomes remains unclear.MethodsA multicenter retrospective cohort study of acute PE patients admitted from emergency departments in Calgary, Canada, between 2012–2017 was used to develop a refined acute PE risk score. The composite primary outcome of in-hospital PE-related death or hemodynamic decompensation. The model was internally validated using bootstrapping and the prognostic value of the derived risk score was compared to the Bova score.ResultsOf 2067 patients with normotensive acute PE, the primary outcome (hemodynamic decompensation or PE related death) occurred in 32 patients (1.5%). In sPESI high-risk patients (n=1498, 78%), a multivariable model used to predict the primary outcome retained computed tomography (CT) right-left ventricular diameter ratio ≥1.5, systolic blood pressure 90–100 mmHg, central pulmonary artery clot, & heart rate ≥100 BMP with a C-statistic of 0.89 (95%CI, 0.82–0.93). Three risk groups were derived using a weighted score (score, prevalence, primary outcome event rate): group 1 (0–3, 73.8%, 0.34%), group 2 (4–6, 17.6%, 5.8%), group 3 (7–9, 8.7%, 12.8%) with a C-statistic 0.85 (95%CI, 0.78–0.91). In comparison the prevalence (primary outcome) by Bova risk stages (n=1179) were: stage I, 49.8% (0.2%); stage II, 31.9% (2.7%); and stage III, 18.4% (7.8%) with a C-statistic 0.80 (95%CI, 0.74–0.86).ConclusionsA simple 4-variable risk score using clinical data immediately available after CT diagnosis of acute PE predicts in-hospital adverse outcomes. External validation of the CAPE score is required.

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