Right ventricular dysfunction in hemodynamically stable patients with acute pulmonary embolism.
BACKGROUND
Echocardiography for risk stratification in hemodynamically stable patients with pulmonary embolism (PE) is well-established. Right ventricular dysfunction (RVD) is associated with an elevated mortality and adverse outcome. The aim of our study was to compare RVD criteria and investigate the role of elevated systolic pulmonary artery pressure (sPAP) in the diagnosis of RVD.


METHODS
We retrospectively analyzed the echocardiographic and laboratory data of all hemodynamically stable patients with confirmed PE (2006-2011). The data were compared with three different definitions of RVD: Definition 1: RV dilatation, abnormal motion of interventricular septum, RV hypokinesis or tricuspid regurgitation. Definition 2: as with definition 1 but including elevated sPAP (>30mmHg). Definition 3: elevated sPAP (>30mmHg) as single RVD criterion.


RESULTS
A total number of 129 patients (59.7% women, age 70.0years (60.7/81.0)) were included in this study. Median Troponin I level was measured as 0.02ng/ml (0/0.14); mean sPAP 33.9±18.5mmHg. The troponin cut-off levels for predicting a RVD of the 3 RVD definitions were in definition 1-3: >0.01ng/ml, >0.01ng/ml and >0.00ng/ml. Analysis of the ROC curve showed an AUC for RVD definitions 1-3: 0.790, 0.796 and 0.635.


CONCLUSIONS
The combination of commonly used RVD criteria with added elevated sPAP improves the diagnosis of RVD in acute PE. Troponin I values of >0.01ng/ml in acute PE point to an RVD.
Department of Medicine II, University Medical Center Mainz, Johannes Gutenberg-University Mainz; Center for Thrombosis and Haemostasis, University Medical Center Mainz, Johannes Gutenberg-University Mainz. Electronic address: Karsten.Keller@unimedizin-mainz.de.
Karsten
K
Keller
Department of Internal Medicine, St. Vincenz and Elisabeth Hospital Mainz (KKM).
Johannes
J
Beule
Department of Medicine II, University Medical Center Mainz, Johannes Gutenberg-University Mainz.
Andreas
A
Schulz
Department of Medicine II, University Medical Center Mainz, Johannes Gutenberg-University Mainz; Center for Thrombosis and Haemostasis, University Medical Center Mainz, Johannes Gutenberg-University Mainz.
Meike
M
Coldewey
Department of Internal Medicine, St. Vincenz and Elisabeth Hospital Mainz (KKM).
Wolfgang
W
Dippold
Department of Radiology and Nuclear Medicine, Catholic Clinic Mainz (KKM); Department of Diagnostic and Interventional Radiology, University Clinic, Johann Wolfgang Goethe-University Frankfurt/Main.
Jörn Oliver
JO
Balzer
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography / Q000379:methods; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism / Q000503:physiopathology*; D012189:Retrospective Studies; D019210:Troponin I / Q000378:metabolism; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging
D019210:Troponin I
Pulmonary artery pressure; Pulmonary embolism; Right ventricular dysfunction; Right ventricular failure; Risk stratification; Troponin