title: Right ventricular function in acute pulmonary embolism: a combined assessment by three-dimensional and speckle-tracking echocardiography.
abstract: BACKGROUND
  The aim of this study was to assess changes in right ventricular (RV) parameters determined by three-dimensional (3D) echocardiography and speckle-tracking echocardiography in patients with acute pulmonary embolism and RV dysfunction without systemic hypotension (submassive pulmonary embolism).
  
  
  METHODS
  Sixty-six patients were prospectively studied at the onset of the acute episode and after median follow-up periods of 30 days and 6 months. Sixty-six controls were selected. RV fractional area change, tricuspid annular plane systolic excursion, and myocardial performance index were determined. RV systolic pressure was assessed using continuous-wave Doppler echocardiography. Three-dimensional RV ejection fraction (RVEF) was calculated. Two-dimensional peak systolic RV longitudinal strain (RVLS) was measured in the basal free wall, mid free wall (MFW), and apical free wall and the septum.
  
  
  RESULTS
  Tricuspid annular plane systolic excursion and fractional area change were smaller and myocardial performance index was larger compared with controls (P < .05). Global RVLS (P < .05), MFW RVLS (P < .001), and 3D RVEF (P < .001) were lower in patients with pulmonary embolism than in controls. There was earlier reversal of MFW RVLS values on 30-day follow-up and longer reversal of 3D RVEF and RV systolic pressure values at 6-month follow-up. Receiver operating characteristic curve analysis showed that changes in 3D RVEF and MFW RVLS were the most sensitive predictors of adverse events. By multivariate analysis, RV systolic pressure (P = .007), MFW RVLS (P = .002), and 3D RVEF (P = .001) were independently associated with adverse outcomes.
  
  
  CONCLUSIONS
  Acute submassive pulmonary embolism has a significant impact on RV function as assessed by 3D echocardiography and speckle-tracking echocardiography. Decreases in MFW RVLS and 3D RVEF may persist during short-term and long-term follow-up and correlate with unfavorable outcomes.
authors: Sapienza University, Rome, Italy. Electronic address: vitar@tiscali.it.
authors: Antonio
authors: A
authors: Vitarelli
authors: Sapienza University, Rome, Italy.
authors: Francesco
authors: F
authors: Barillà
authors: Sapienza University, Rome, Italy.
authors: Lidia
authors: L
authors: Capotosto
authors: Sapienza University, Rome, Italy.
authors: Ilaria
authors: I
authors: D'Angeli
authors: Sapienza University, Rome, Italy.
authors: Giovanni
authors: G
authors: Truscelli
authors: Sapienza University, Rome, Italy.
authors: Melissa
authors: M
authors: De Maio
authors: Sapienza University, Rome, Italy.
authors: Rasul
authors: R
authors: Ashurov
mesh_terms: D000208:Acute Disease; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D064847:Multimodal Imaging / Q000379:methods*; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013314:Stress, Mechanical; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*
keywords: Echocardiography; Pulmonary embolism; Right ventricular function; Speckle-tracking echocardiography; Three-dimensional echocardiography