title: Assessment of right and left ventricular diastolic functions with tissue Doppler echocardiography in congestive heart failure patients with coexisting acute pulmonary embolism.
abstract: BACKGROUND
  Acute pulmonary embolism (APE), despite improvements in diagnostic methods, often remains undiagnosed. Recently, systolic dysfunction has also been described as assessed by new echocardiographic techniques, such as tissue Doppler imaging (TDI).
  
  
  OBJECTIVE
  In our study we have attempted to assess diastolic function within the mitral and tricuspid annuli in congestive heart failure (CHF) patients with coexisting APE.
  
  
  METHODS
  The study included 39 patients with CHF with sinus rhythm, 20 patients with confirmed APE (PE+), and 19 patients with excluded APE (PE-). APE was confirmed or excluded on the result of spiral chest computed tomography. Tissue Doppler imaging (TDI) was performed to measure early diastolic velocity (Em), late diastolic velocity (Am) of both examined annuli, and Em/AmLV and Em/AmRV ratios.
  
  
  RESULTS
  PE+ subjects were found to have lower EmRV than PE- subjects [4.2 (2.0-14) vs. 6.5 (0.8-14) cm/s; p = 0.006]. The AmLV was higher in the PE+ vs. PE- group [8.4 (3.0-15.2) vs. 3.0 (1.0-14.8), p = 0.0038]. Em/AmLV and Em/AmRV were significantly lower in the PE + vs. PE- group [0.55 (0.2-1.4) vs. 1.6 (0.16-5.4), p = 0.0089 and 0.41 (0.17-2.5) vs. 1.5 (0.05-5.5), p = 0.0069]. For the APE diagnosis, the area under the ROC curve calculated for AmLV and Em/AmLV was 0.771 (95% CI 0.509-0.890) and 0.742 (95% CI 0.577-0.868) respectively. For the APE diagnosis, the sensitivity, specificity, positive and negative predictive values for AmLV = 4.9 cm/s were: 95%, 68.4%, 76% and 92.9%, respectively and for Em/AmLV = 1.0 were: 95%, 63.2%, 73.1% and 92.3%, respectively.
  
  
  CONCLUSIONS
  TDI reveals changes in mitral and tricuspid annular velocities in CHF patients with confirmed APE. These patients exhibit a reduced EmRV and increased AmLV.
authors: Department of Internal Medicine, Gastroenterology and Hepatology, University Clinical Hospital, University of Warmia and Mazury, Olsztyn, Poland.
authors: Leszek
authors: L
authors: Gromadziński
authors: Department of Internal Medicine and Cardiology, Municipal Hospital, Olsztyn, Poland.
authors: Ryszard
authors: R
authors: Targoński
authors: Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
authors: Piotr
authors: P
authors: Pruszczyk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012372:ROC Curve; D036542:Tomography, Spiral Computed; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right