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d-Dimer and simplified pulmonary embolism severity index in relation to right ventricular function
Riikka Rydman1, Mårten Söderberg, Flemming Larsen
1Section of Clinical Physiology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. riikka.rydman@karolinska.se
The American Journal of Emergency Medicine
|November 17, 2012
Summary
In pulmonary embolism (PE), a d-dimer level of 3 mg/L or higher can identify right ventricular (RV) dysfunction in nonmassive PE patients. The simplified PE severity index (sPESI) did not add value in this context.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Diagnostic Imaging
Background:
- Right ventricular (RV) involvement in pulmonary embolism (PE) is a critical prognostic indicator.
- Assessing RV dysfunction is crucial for risk stratification in nonmassive PE patients with preserved systemic arterial pressure.
Purpose of the Study:
- To evaluate the utility of d-dimer levels and the simplified PE severity index (sPESI) in identifying RV dysfunction in acute nonmassive PE.
- To determine if these markers can aid in risk profiling patients with preserved systemic arterial pressure.
Main Methods:
- Echocardiography with Doppler tissue imaging was used to assess RV function in 34 consecutive patients with acute nonmassive PE.
- d-Dimer levels and sPESI were measured upon patient arrival.
Main Results:
- d-Dimer levels showed significant correlations with RV pressure and pulmonary vascular resistance (PVR).
- Patients with d-dimer ≥ 3.0 mg/L exhibited lower systolic tricuspid annular velocity, prolonged myocardial performance index (MPI), and increased RV pressure and PVR compared to those with lower levels.
- Elevated sPESI scores were associated with higher filling pressures, but d-dimer proved more indicative of RV dysfunction.
Conclusions:
- A d-dimer level of 3 mg/L or higher is a valuable marker for identifying RV dysfunction in the acute phase of nonmassive PE.
- This finding aids in risk stratification for patients with preserved systemic arterial pressure.
- The sPESI did not provide additional prognostic value beyond d-dimer for assessing RV dysfunction in this cohort.
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