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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; Boulate, David; Krishnan, Gomathi; Liang, David; Schnittger, Ingela; Fleischmann, Dominik; McConnell, Michael V; Haddad, François.
Afiliación
  • Tuzovic M; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
  • Adigopula S; Stanford Cardiovascular Institute, Stanford University School of Medicine, 300 Pasteur Drive, Palo Alto, CA, USA.
  • Amsallem M; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
  • Kobayashi Y; Stanford Cardiovascular Institute, Stanford University School of Medicine, 300 Pasteur Drive, Palo Alto, CA, USA.
  • Kadoch M; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA. myriam.amsallem@gmail.com.
  • Boulate D; Stanford Cardiovascular Institute, Stanford University School of Medicine, 300 Pasteur Drive, Palo Alto, CA, USA. myriam.amsallem@gmail.com.
  • Krishnan G; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
  • Liang D; Stanford Cardiovascular Institute, Stanford University School of Medicine, 300 Pasteur Drive, Palo Alto, CA, USA.
  • Schnittger I; Division of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
  • Fleischmann D; Unité de Recherche Clinique, Marie Lannelongue Hospital, University of Paris XI, Le Plessis Robinson, France.
  • McConnell MV; Center for Clinical Informatics, Stanford University Medical Center, Palo Alto, CA, USA.
  • Haddad F; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Int J Cardiovasc Imaging ; 32(3): 389-98, 2016 Mar.
Article en En | MEDLINE | ID: mdl-26428674
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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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fragmentos de Péptidos / Embolia Pulmonar / Troponina / Coagulación Sanguínea / Función Ventricular Derecha / Disfunción Ventricular Derecha / Péptido Natriurético Encefálico Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Int J Cardiovasc Imaging Asunto de la revista: DIAGNOSTICO POR IMAGEM Año: 2016 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fragmentos de Péptidos / Embolia Pulmonar / Troponina / Coagulación Sanguínea / Función Ventricular Derecha / Disfunción Ventricular Derecha / Péptido Natriurético Encefálico Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Int J Cardiovasc Imaging Asunto de la revista: DIAGNOSTICO POR IMAGEM Año: 2016 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos