Original articleNatural History of Right Ventricular Dysfunction After Acute Pulmonary Embolism
Section snippets
Methods
From 2004 to 2006, consecutive adult patients in the emergency department of a tertiary referral hospital presenting with a clinical history of suspected acute PE and ventilation/perfusion pulmonary scintigraphy demonstrating high probability for PE who agreed to regular investigations for 6 months were included in the study (n = 35; 18 of 35 male; 17 of 35 had large PE ≥ 30% lung volume, 9 of 35 had massive PE ≥ 50% lung volume). The study was approved by our human ethics committee. Written
Results
The patient characteristics are summarized in Table 1. The day-1 D-dimer (2.2 ± 3.2, normal < 0.25 mg/L), BNP (130 ± 222, normal < 100 pg/mL), troponin-T (0.02 ± 0.02, normal < 0.01 μg/L), and DLCO (69 ± 15% of reference value) were abnormal compared with reference standards. Four patients (11%) had bleeding complications, however, none required blood transfusion. One patient developed intracranial hemorrhage while on oral anticoagulation. There were no in-hospital deaths. Two patients died
Discussion
The identification of robust and reproducible parameters of RV function has the potential to substantially improve the treatment of patients with acute PE. We report for the first time that TAM and RV basal Am are strongly predictive of PE size, and that whereas RV dilatation improves during 6 weeks, subclinical RV systolic dysfunction persists beyond 3 months.
Our results indicate that TAM (P = .0001) is the strongest independent echocardiographic marker of embolic load in acute PE, and
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2020, ChestCitation Excerpt :As depicted in Figure 4, we suspect that SVI carries higher predictive value of in-hospital PE-related events because it identifies patients who have progressed further down this pathophysiologic spiral into a state of compensated normotensive shock. We suspect that SVI was superior to other TTE variables that were measured in this study because parameters of RV dilation, contractility, and neurohormonal activation are common early findings in PE that typically fully recover.25 A major strength of this large multi-hospital study was the inclusion of a large cohort of 665 intermediate-risk patients who underwent blinded multi-reviewer analysis of TTE variables.
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2017, Journal of the American College of CardiologyCitation Excerpt :In fact, some degree of persistent pulmonary hypertension or RV dysfunction has been reported in as many as 40% of survivors followed over 6 months to 1 year after acute PE (16). However, the number of patients followed in cohort studies was rather small, standardization of the echocardiographic parameters remains a largely unresolved issue, and, most importantly, a correlation of ultrasound findings with the severity of patients’ symptoms or the degree of functional limitation at follow-up could not be demonstrated (17). In the present study, echocardiographic follow-up, which was performed in 290 randomized patients, yielded 1 or more indicators of pulmonary hypertension and/or RV dysfunction in a high proportion (44%) of the patient population.
N-terminal Pro-brain Natriuretic Peptide, High-sensitivity Troponin and Pulmonary Artery Clot Score as Predictors of Right Ventricular Dysfunction in Echocardiography
2016, Heart Lung and CirculationCitation Excerpt :First, the number of patients is relatively small as well as the number of patients with residual RVD reflecting a lower risk cohort and potentially affecting the statistical power of the study. Second, signs of RVD assessed by TTE, which was performed six hours later than CTPA and blood collection for cardiac biomarkers, might have been influenced by management during the delay [33]. We assume, however, that since patients with clinically high-risk APE were excluded from the study and only three patients received thrombolysis, the haemodynamic changes within 12 hours after the time of diagnosis were minimal.
Right Ventricular Systolic Function Responses to Acute and Chronic Pulmonary Hypertension: Assessment with Myocardial Deformation
2016, Journal of the American Society of EchocardiographyCitation Excerpt :The most common cause of death at 90 days is RV failure. In a study specifically examining echocardiographic markers of 6-month patient outcomes and recovery of RV function, the time course of recovery showed that RV dilatation improved after 3 weeks, but subclinical RV dysfunction persisted for up to 3 months.19 We found that RVEDA was the weakest discriminator of chronic versus acute pressure overload.