title: Echocardiographic evaluation of right ventricular function in patients with acute pulmonary embolism: a study using tricuspid annular motion.
abstract: Assessment of right ventricular (RV) function is a challenge due to complex anatomy. We studied systolic and diastolic tricuspid annular excursion and longitudinal RV fractional shortening as geometry-independent measures in patients with acute pulmonary embolism (PE). Forty patients with PE were studied within 24 hours after admission and after 3 months, and compared to 23 healthy subjects used as controls. We recorded tricuspid annular plane systolic (TAPSE) and diastolic (TAPDE) excursion from the four-chamber view and calculated RV fractional shortening as TAPSE/RV diastolic length. The diastolic RV function was defined as the ratio of the amplitude of tricuspid annular plane excursion during atrial systole to total tricuspid annular plane diastolic excursion (atrial/total TAPDE). In the acute stage, the TAPSE was decreased in PE compared to healthy subjects (19 +/- 5 vs. 26 +/- 4 mm, P < 0.001), with greater reduction in patients with increased, compared to normal, RV pressure (16.6 +/- 5 vs. 20.5 +/- 5 mm, P < 0.05). The atrial/total TAPDE was increased in patients compared to healthy subjects (47 +/- 13% vs. 38 +/- 7%, P < 0.001) and normalized during the follow-up. Although the patients were asymptomatic after 3 months, the TAPSE recovered incompletely as compared to healthy subjects (21.4 +/- 4 vs. 26 +/- 4 mm, P < 0.001). Both systolic and diastolic RV function are impaired in acute PE. Diastolic function recovers faster than systolic; therefore, the atrial contribution to RV filling may be a useful measure to follow changes in diastolic function in PE.
authors.affiliation: Section of Clinical Physiology, Department of Molecular Medicine and Surgery, Karolinska University Hospital, SE-171 76 Stockholm, Sweden. riikka.rydman@karolinska.se
authors.forename: Riikka
authors.initials: R
authors.lastname: Rydman
authors.forename: Mårten
authors.initials: M
authors.lastname: Söderberg
authors.forename: Flemming
authors.initials: F
authors.lastname: Larsen
authors.forename: Kenneth
authors.initials: K
authors.lastname: Caidahl
authors.forename: Mahbubul
authors.initials: M
authors.lastname: Alam
mesh_terms: D003971:Diastole; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D012015:Reference Standards; D013599:Systole; D014261:Tricuspid Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D016278:Ventricular Function, Right