Right ventricular dysfunction in hemodynamically stable patients with acute pulmonary embolism.

Area of Science:

• Cardiology
• Pulmonology
• Diagnostic Imaging

Background:

• Echocardiography is established for risk stratification in hemodynamically stable pulmonary embolism (PE) patients.
• Right ventricular dysfunction (RVD) in PE is linked to increased mortality and adverse outcomes.
• Investigating optimal RVD diagnostic criteria in PE is crucial.

Purpose of the Study:

• To compare different echocardiographic criteria for diagnosing RVD in PE.
• To evaluate the role of elevated systolic pulmonary artery pressure (sPAP) in RVD diagnosis.
• To determine the diagnostic accuracy of combined RVD criteria and sPAP.

Main Methods:

• Retrospective analysis of echocardiographic and laboratory data from hemodynamically stable PE patients (2006-2011).
• Comparison of three RVD definitions: Definition 1 (RV dilatation, septal motion, hypokinesis, tricuspid regurgitation), Definition 2 (Definition 1 + elevated sPAP >30mmHg), Definition 3 (elevated sPAP >30mmHg alone).
• Analysis of Troponin I levels and Receiver Operating Characteristic (ROC) curves to assess diagnostic performance.

Main Results:

• 129 PE patients (59.7% female, median age 70.0 years) were included.
• Mean sPAP was 33.9±18.5mmHg; median Troponin I was 0.02ng/ml.
• Area Under the Curve (AUC) for RVD definitions 1, 2, and 3 were 0.790, 0.796, and 0.635, respectively. Troponin I cut-off for RVD was >0.01ng/ml for definitions 1 and 2, and >0.00ng/ml for definition 3.

Conclusions:

• Combining standard RVD echocardiographic criteria with elevated sPAP enhances RVD diagnosis in acute PE.
• Troponin I levels >0.01ng/ml are indicative of RVD in acute PE patients.
• Definition 2, incorporating elevated sPAP, showed the highest diagnostic accuracy (AUC 0.796).