The significance of mitral and tricuspid valve systolic lateral annular velocities in the diagnosis of acute pulmonary embolism in patients with chronic heart failure.
BACKGROUND
The diagnosis of acute pulmonary embolism (APE) in patients with chronic heart failure (CHF) remains a difficult task, despite the refinement of imaging techniques. The goal of this study was to assess the value of measuring tricuspid and mitral valve systolic annular velocities in CHF patients with suspected PE by tissue Doppler imaging (TDI).


METHODS
The study included 75 patients with previously diagnosed CHF, admitted due to resting dyspnea, with a maximum tricuspid regurgitation pressure gradient (TRPG) of ≥ 35 mm Hg and positive D-dimer assay. Spiral computed tomography (sCT) was performed on all subjects to confirm APE. Acute pulmonary embolism was diagnosed in 35 patients (PE+), and excluded in 40 others (PE-). Tissue Doppler imaging was performed to measure maximum systolic lateral annular velocities in the mitral (SmLV) and tricuspid (SmRV) valves, as well as the SmRV/SmLV ratio.


RESULTS
PE+ subjects were found to have higher SmLV than PE- subjects (6.0 cm/s (2.0-13.8 cm/s) vs. 4.2 cm/s (1.3-9.1 cm/s), p = 0.003). SmRV/SmLV ratios were 1.05 (0.50-2.50) and 1.56 (0.62-4.30), respectively (p < 0.0001). Areas under ROC curves for diagnosis of APE were 0.700 for SmLV and 0.789 for SmRV/SmLV. In multivariate logistic regression analysis, only SmRV/SmLV was statistically significant, with an odds ratio for APE of 6.26 (95% CI: 1.53-25.59; p = 0.009).


CONCLUSIONS
Tissue Doppler imaging of the lateral tricuspid and mitral annuli is a useful clinical tool that can help identify PE in CHF patients. Those patients who fulfill these criteria should be considered for further diagnostic studies to confirm PE.
Department of Internal Medicine, Gastroenterology and Hepatology, University Hospital, University of Warmia and Mazury, Olsztyn, Poland ; Department of Internal Medicine, Cardiology and Nephrology, Hospital, Ostroda, Poland.
Leszek
L
Gromadziński
Department of Internal Medicine and Cardiology, Municipal Hospital, Olsztyn, Poland.
Ryszard
R
Targoński
Department of Internal Medicine, Gastroenterology and Hepatology, University Hospital, University of Warmia and Mazury, Olsztyn, Poland ; Department of Internal Medicine, Cardiology and Nephrology, Hospital, Ostroda, Poland.
Beata
B
Januszko-Giergielewicz
Department of Internal Medicine and Cardiology, Warsaw Medical University, Warsaw, Poland.
Philip
P
Ostrowski
Department of Internal Medicine and Cardiology, Warsaw Medical University, Warsaw, Poland.
Piotr
P
Pruszczyk
chronic heart failure; pulmonary embolism; tissue Doppler imaging