Right ventricular assessment by tissue-doppler echocardiography in acute pulmonary embolism
Rodrigues ACT., Cordovil A., Monaco C., Guimarães L., Cury A., Naccarato GAF., Lira-Filho E., Fischer CH., Vieira MLC., Morhy S.
Background: Assessment of the right ventricular (RV) function by echocardiography in patients with pulmonary thromboembolism (PE) is complex and frequently qualitative. Tissue Doppler has been used for the semiquantitative assessment of this chamber, although with some limitations. Objective: To evaluate RV function in PE using tissue-Doppler echocardiography, in addition to atrial natriuretic peptide (BNP). Methods: Patients with PE were studied using tissue-Doppler echocardiography and BNP up to 24 hours after diagnosis; myocardial velocities (s'), strain, strain rate and RV myocardial performance index were obtained. RV dysfunction was diagnosed by chamber hypokinesia, abnormal septal motion and a RV/LV ratio ≥1. According to their BNP levels, the patients were divided into Group I, BNP < 50 pg/mL and Group II, BNP ≥ 50 pg/mL. Results: Of 118 patients, 100 (60 men, age = 55 ± 17 years) were analyzed; RV dysfunction was observed in 28%, more frequently in group II (19 vs. 9 patients, p < 0.001). Patients in group II were older (64 ± 19 vs. 50 ± 15 years), and had lower s' velocity (10.5 ± 3.5 vs. 13.2 ± 3.1 cm/s), and higher pulmonary pressure (48 ± 11 vs. 35 ± 11 mmHg), p < 0.001. The cut-off point of s' for RV dysfunction was 10.8 cm/s (specificity = 85%, sensitivity = 54%), with moderate correlation between BNP and s' wave (r = -0.39). Conclusion: In PE, RV dysfunction on echocardiography is accompanied by BNP elevation; although tissue- Doppler imaging adequately confirms the presence of RV dysfunction, it has a limited sensitivity for this diagnosis.