title: Right ventricular assessment by tissue-Doppler echocardiography in acute pulmonary embolism.
abstract: BACKGROUND
  Assessment of the right ventricular (RV) function by echocardiography in patients with pulmonary thromboembolism (PTE) 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 PTE using tissue-Doppler echocardiography, in addition to atrial natriuretic peptide (BNP).
  
  
  METHODS
  Patients with PTE 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).
  
  
  CONCLUSIONS
  In PTE, 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.
authors: Hospital Israelita Albert Einstein, MDP Ecocardiografia, São Paulo, SP, Brazil. claratude@yahoo.com
authors: Ana Clara Tude
authors: AC
authors: Rodrigues
authors: Adriana
authors: A
authors: Cordovil
authors: Claudia
authors: C
authors: Monaco
authors: Laise
authors: L
authors: Guimarães
authors: Alexandre
authors: A
authors: Cury
authors: Gustavo A F
authors: GA
authors: Naccarato
authors: Edgar
authors: E
authors: Lira-Filho
authors: Claudio Henrique
authors: CH
authors: Fischer
authors: Marcelo Luiz Campos
authors: ML
authors: Vieira
authors: Samira
authors: S
authors: Morhy
mesh_terms: D000328:Adult; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011655:Pulmonary Embolism / Q000097:blood / Q000503:physiopathology*; D012372:ROC Curve; D018497:Ventricular Dysfunction, Right / Q000097:blood / Q000000981:diagnostic imaging* / Q000503:physiopathology
chemical_list: D009320:Atrial Natriuretic Factor