Doppler imaging predicts cardiac events in chronic pulmonary thromboembolism.
OBJECTIVE
We evaluated whether right ventricular (RV) diastolic dysfunction assessed by pulsed tissue Doppler imaging (TDI) predicts cardiac events in patients with chronic pulmonary thromboembolism (CPTE).


METHODS
In 63 consecutive patients with CPTE, early diastolic myocardial velocity (Ea) at the tricuspid annulus by TDI and early diastolic tricuspid inflow (E) by conventional pulsed Doppler were obtained, and E/Ea was calculated as an indicator of RV diastolic dysfunction. Brain natriuretic peptide (BNP) and other echo parameters were also obtained. A cardiac event (rehospitalization caused by congestive heart failure or cardiac death) was the study endpoint. Incidence of cardiac events was determined over a 374+/-451 day follow-up period.


RESULTS
In the follow-up period twelve patients had cardiac events. We divided patients into group A with cardiac events and group B without events. E/Ea was significantly increased in group A as compared with group B (8.3+/-4.1 vs. 5.7+/-2.6, p<0.01). BNP was higher in group A than group B (221+/-191 vs. 121+/-140 mg/dl, p<0.05), and in addition E/Ea was significantly positively correlated with BNP (r=0.48, p<0.001). A logistic regression model for predicting cardiac events was constructed and E/Ea was associated with an increased incidence of cardiac events (relative risk=1.33, 95% CI 1.00-1.75).


CONCLUSIONS
Elevated values of E/Ea obtained by TDI may predict cardiac events in patients with CPTE. BNP may also be a significant predictor.
Shiina
Yumi
Y
Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Inohana 1-8-1, Chuo-ku, Chiba City, Chiba 260-8670, Japan.
Funabashi
Nobusada
N
Lee
Kwangho
K
Daimon
Masao
M
Sekine
Tai
T
Kawakubo
Miyuki
M
Sekine
Yukiko
Y
Takahashi
Maiko
M
Yajima
Rei
R
Wakatsuki
Yu
Y
Tanabe
Nobuhiro
N
Kuriyama
Takayuki
T
Komuro
Issei
I
D000328:Adult; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D003643:Death; D003971:Diastole; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000097:blood / Q000150:complications*; D018497:Ventricular Dysfunction, Right / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain