Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2014, vol. 23, nr 3, May-June, p. 371–376

Publication type: original article

Language: English

Assessment of Right and Left Ventricular Diastolic Functions with Tissue Doppler Echocardiography in Congestive Heart Failure Patients with Coexisting Acute Pulmonary Embolism

Leszek Gromadziński1,A,B,C,D,E,F, Ryszard Targoński2,A,B,E,F, Piotr Pruszczyk3,A,C,E,F

1 Department of Internal Medicine, Gastroenterology and Hepatology, University clinical Hospital, University of Warmia and Mazury, Olsztyn, Poland

2 Department of Internal Medicine and cardiology, Municipal Hospital, Olsztyn, Poland

3 Department of Internal Medicine and cardiology, Medical University of Warsaw, Poland

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).
Objectives. 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.
Material and 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 Pesubjects [4.2 (2.0–14) vs. 6.5 (0.8–14) cm/s; p = 0.006]. The amLV was higher in the Pe+ vs. Pegroup [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. Pegroup [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.
Conclusion. TDI reveals changes in mitral and tricuspid annular velocities in cHf patients with confirmed aPe. These patients exhibit a reduced emRV and increased amLV.

Key words

tissue Doppler, diastolic function, acute pulmonary embolism.

References (20)

  1. Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galie N, Pruszczyk P, Bengel F, Brady AJ, Ferreira D, Janssens U, Klepetko W, Mayer E, Remy-Jardin M, Bassand JP: eSc committee for Practice Guidelines (cPG). Guidelines on the diagnosis and management of acute pulmonary embolism. eur Heart J 2008, 29, 2276–2315.
  2. Kasper W, Gelbel A, Tiede N, Bassenge D, Kauder E, Konstantinides S, Meinertz T, Just H: Distinguishing between acute and subacute massive pulmonary embolism by conventional and Doppler echocardiography. br Heart J 1993, 70, 352–356.
  3. Kasper W, Meinertz T, Henkel B, Eissner D, Hahn K, Hofmann T, Zeiher A, Just H: echocardiographic findings in patients with proved pulmonary embolism. am Heart J 1986, 112, 1284–1290.
  4. Jardin F, Dubourg O, Gueret P, Delorme G, Bourdarias JP: Quantitative two-dimensional echocardiography in massive pulmonary embolism: emphasis on ventricular interdependence and leftward septal displacement. J am coll cardiol 1987, 10, 1201–1206.
  5. McConnell MV, Solomon SD, Rayan ME, Come PC, Goldhaber SZ, Lee RT: Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism. am J cardiol 1996, 78, 469–473.
  6. Miniati M, Monti S, Pratali L, Di Ricco G, Marini C, Formichi B, Prediletto R, Michelassi C, Di Lorenzo M, Tonelli L, Pistolesi M: Value of transthoracic echocardiography in the diagnosis of pulmonary embolism: Results of a prospective study in unselected patients. am J Med 2001, 110, 528–535.
  7. Nazeyrollas P, Metz D, Jolly D, Maillier B, Jennesseaux C, Maes D, Chabert JP, Chapoutot L, Elaerts J: Use of transthoracic Doppler echocardiography combined with clinical electrocardiographic data to predict acute pulmonary embolism. eur Heart J 1996, 17, 779–786.
  8. Perrier A, Tamm C, Unger PF, Lerch R, Sztajzel J: Diagnostic accuracy of Doppler echocardiography in unselected patients with suspected pulmonary embolism. Int J cardiol 1998, 65, 101–109.
  9. Grifoni S, Olivotto I, Cecchini P, Pieralli F, Camaiti A, Santoro G, Pieri A, Toccafondi S, Magazzini S, Berni G, Agnelli G: Utility of an integrated clinical, echocardiographic, and venous ultrasonographic approach for triage of patients with suspected pulmonary embolism. am J cardiol 1998, 82, 1230–1235.
  10. Kurzyna M, Torbicki A, Pruszczyk P, Burakowska B, Fijałkowska A, Kober J, Oniszh K, Kuca P, Tomkowski W,Burakowski J, Wawrzyńska L: Disturbed right ventricular ejection pattern as a new Doppler echocardiographic sign of acute pulmonary embolism. am J cardiol 2002, 90, 507–511.
  11. Torbicki A, Kurzyna M, Ciurzyński M, Pruszczyk P, Pacho R, Kuch-Wocial A, Szulc M: Proximal pulmonary embolism modifies right ventricular ejection pattern. eur Respir J 1999, 13, 616–621.
  12. Gromadzinski L, Ciurzynski M, Januszko-Giergielewicz B, Targoński R, Cygański P, Pruszczyk P: Diagnostic value of mitral and tricuspid annular excursion in the diagnostics of acute pulmonary embolism patients with chronic heart failure. Int J cardiol 2011, 149, 118–119.
  13. Pruszczyk P, Torbicki A, Pacho R, Chlebus M, Kuch-Wocial A, Pruszynski B, Gurba H: Noninvasive diagnosis of suspected severe pulmonary embolism: transesophageal echocardiography vs spiral cT. chest 1997, 112, 722–728.
  14. Kjaergaard J, Krogdgaard BK, Lund JO, Hassager C: Quantitative Measures of right ventricular dysfunction by echocardiography in the diagnosis of acute nonmassive pulmonary embolism. J am Soc echocardiography 2006, 19, 1264–1271.
  15. Hsiao SH, Chang SM, Lee ChY, Yang SH, Lin SK, Chiou KR: Usefulness of tissue Doppler parameters for identifying pulmonary embolism in patients with signs of pulmonary hypertension. am J cardiol 2006, 98, 685–690.
  16. Hsiao SH, Lee CY, Chang SM, Yang SH, Lin SK, Huang WC: Pulmonary embolism and right heart function: Insights from myocardial Doppler tissue imaging. J am Soc echocardiography 2006, 19, 822–828.
  17. Hsiao SH, Yang SH, Wang WC, Lee CY, Lin SK, Liu CP: Usefulness of regional myocardial performance index to diagnose pulmonary embolism in patients with echocardiographic signs of pulmonary hypertension. am J cardiol 2006, 98, 1652–1655.
  18. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ: chamber Quantification Writing Group; american Society of echocardiography’s Guidelines and Standards committee; european association of echocardiography. Recommendations of chamber quantification: a report from the american Society of echocardiography’s Guidelines and Standards committee and the chamber Quantification Writing Group, d
  19. Gromadziński L, Targoński R: The role of tissue colour Doppler imaging in diagnosis of segmental pulmonary embolism in congestive heart failure patients. Kardiol Pol 2007, 65, 1433–1439.
  20. Rydman R, Larsen F, Caidahl K, Alam M: Right ventricular function in patients with pulmonary embolism: early and late findings using Doppler tissue imaging. J am Soc echocardiogr 2010, 23, 531–537.
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