Evaluation of right ventricular function in acute pulmonary embolism by 3D ejection fraction and longitudinal strain echocardiography in acute phase and follow-up

Abstract Background Assessment of right ventricular (RV) function by transthoracic echocardiography (TTE) in acute pulmonary embolism (PE) has an essential role to severity stratification. However, there is no reliable information on RV function about the clinical utility of advanced TTE parameters in follow-up. Purpose We aimed to assess the clinical utility of 3D RV ejection fraction (3DEF) and free wall longitudinal strain (FWLS) compared to conventional parameters in evaluating RV function in patients with acute PE at time of diagnosis and after follow-up and the relation with adverse outcomes. Methods We prospectively recruited 86 patients with intermediate-high and high-risk bilateral PE from 2018 to 2020 in our centre. Patients underwent TTE during admission and at 6 to 12 months follow-up that included conventional RV parameters (pulsed Doppler S wave (S'), TAPSE, and fractional area change (FAC)). 3DEF and FWLS were obtained as well. Normal values were stablished according to European guidelines. Results Mean age was 63.7±16.5 years, 58% males. Reperfusion treatment was performed in a 26,8%. In-hospital mortality was 4,7% (3 patients in the acute phase of PE and 1 due to rePE. The median follow-up was 1.3 years (IQR 1–2.5). 9 patients died (2 due to PE, 3 due to respiratory failure and 5 due to cancer). Patients with adverse events had a greater severity in PESI scale and worse RV function assessed by 3DEF and 3D volumes. There were no significant differences between groups in FAC, S' and TAPSE (Table 1). Baseline echocardiographic parameters were analyzed in the acute phase during admission and at 6–12 month follow-up (Table 2). There was a significant improvement in conventional parameters (TAPSE and FAC) and a reversal of FWLS values (P=0,01) at follow-up. 3DEF improved, but was not statistically significant (p=0,06). There was a greater reversal in end-systolic volume compared to end-diastolic volume. Conclusion Advanced RV function assessment by 3DEF and FWLS is useful in the acute phase and follow-up. FWLS showed and early normalization after PE resolution, whereas 3DEF improved but remained pathological at 6–12 months follow-up. Funding Acknowledgement Type of funding sources: None. Table 1Table 2 </jats:sec

Diagnostic performance of conventional right ventricular function echocardiography parameters in acute pulmonary embolism. Comparison with 3D ejection fraction and longitudinal strain

Abstract Background Assessment of right ventricular (RV) function by transthoracic echocardiography (TTE) in acute pulmonary embolism (PE) has an essential role to stratify the severity. However, there is no individual TTE parameter that seems to provide reliable information on RV function. Purpose The objective is to compare the usefulness of advanced echocardiographic parameters, 3D RV ejection fraction (3DEF) and free wall 2D TTE speckle-tracking (2D-ST), in comparison to conventional ones in the RV dysfunction evaluation in patients with acute PE. Methods We prospectively recruited 86 patients with intermediate-high and high-risk bilateral PE from 2018 to 2020 in our centre. TTE during admission included 3DRVEF and 2D-ST and conventional parameters (pulsed tissue Doppler S wave (S'), TAPSE, and fractional area change (FAC)). Normal values were stablished according to European guidelines. Results Mean age was 63.7±16.5 years, 58% males. Reperfusion treatment was performed in a 26.8%. Characteristics at admission and ETT parameters are shown on Table1. The proportion of patients with RV dysfunction evaluated by conventional parameters (42.9% by CAF, 20.8% by TAPSE and 17.7% by S') was lower than using 3DEF and ST (74.5% and 66,7% respectively). Correlation amongst parameters is depicted in table2. FAC had the best correlation with 3DEF and FWLS (p&amp;lt;0.001). If considering 3DEF as “gold standard” in this cohort, FAC had the best performance to detect RV systolic dysfunction with a sensitivity and specificity of 45.9% and 93.2%, respectively, and a positive predictive value of 94.4%. TAPSE and S' had sensitivity of 21.6% and 17.1% respectively and 100% specificity. FWLS had 84.2% and 84.6% of sensitivity and specificity with a positive and negative predictive value of 94.1% and 64.7% respectively. Conclusion Advanced RV function assessmentby 3DEF and 2D-ST can help to identify a greater number of patients with RV dysfunction in high and intermediate-high risk acute PE compared with conventional parameters. FAC seems to be the best option to asses RV systolic function if 3D echo is not available. Funding Acknowledgement Type of funding sources: None. Table 1Table 2 </jats:sec