Right ventricle dysfunction and pulmonary hypertension in hemodynamically stable pulmonary embolism

The main objectives of this study were to determine the incidence of echocardiography-detected right ventricle dysfunction (RVD) or pulmonary hypertension (PHT) and its correlation with computed tomography pulmonary angiography (CTPA) in hemodynamically stable patients with pulmonary embolism (PE), both at diagnosis and after 6 months follow-up.

Prospective, descriptive, single-center follow-up study.

103 consecutive patients, with a life expectancy of >6 months, presenting with PE and a systolic blood pressure> or =90mmHg. Echocardiography and CTPA were performed at diagnosis and after 6 months.

At diagnosis, RVD and isolated PHT were found in 24.5% and 19.6% of patients, respectively. CTPA and echocardiography correlated significantly at diagnosis. However, CTPA could not predict accurately RVD or PHT. Persistence of RVD and isolated PHT was observed in 7.9% and 11.8% of cases, respectively, 6 months later. Intraluminal filling defects disappeared in 79%. No new filling defects were seen in any patient. Excluding cases with comorbidities that might account for PHT, CTPA was normal at the 6th month in 23.1% of patients with and in 87.8% of cases without persistent RVD or PHT, respectively (p<0.0001).

RVD or PHT are a frequent finding at diagnosis in patients with hemodynamically stable pulmonary embolism and they persist at 6 months in a significant proportion of cases. We have observed a relationship between the persistence of residual vascular obstruction in CTPA and RVD or PHT 6 months after PE.