Tuzovic Mirela, Adigopula Sasikanth, Amsallem Myriam, Kobayashi Yukari, Kadoch Michael, Boulate David, Krishnan Gomathi, Liang David, Schnittger Ingela, Fleischmann Dominik, McConnell Michael V, Haddad François
Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Stanford Cardiovascular Institute, Stanford University School of Medicine, 300 Pasteur Drive, Palo Alto, CA, USA.
Int J Cardiovasc Imaging. 2016 Mar;32(3):389-98. doi: 10.1007/s10554-015-0780-1. Epub 2015 Oct 1.
Regional right ventricular (RV) dysfunction (RRVD) is an echocardiographic feature in acute pulmonary embolism (PE), primarily reported in patients with moderate-to-severe RV dysfunction. This study investigated the clinical importance of RRVD by assessing its relationship with clot burden and biomarkers. We identified consecutive patients admitted to the emergency department between 1999 and 2014 who underwent computed tomographic angiography, echocardiography, and biomarker testing (troponin and NT-proBNP) for suspected acute PE. RRVD was defined as normal excursion of the apex contrasting with hypokinesis of the mid-free wall segment. RV assessment included measurements of ventricular dimensions, fractional area change, free-wall longitudinal strain and tricuspid annular plane systolic excursion. Clot burden was assessed using the modified Miller score. Of 82 patients identified, 51 had acute PE (mean age 66 ± 17 years, 43% male). No patient had RV myocardial infarction. RRVD was present in 41% of PEs and absent in all patients without PE. Among patients with PE, 86% of patients with RRVD had central or multi-lobar PE. Patients with RRVD had higher prevalence of moderate-to-severe RV dilation (81 vs. 30%, p < 0.01) and dysfunction (86 vs. 23%, p < 0.01). There was a strong trend for higher troponin level in PE patients with RRVD (38 vs. 13% in PE patients without RRVD, p = 0.08), while there was no significant difference for NT-proBNP (67 vs. 73%, p = 0.88). RRVD showed good concordance between readers (87%). RRVD is associated with an increased clot burden in acute PE and is more prevalent among patients with moderate-to-severe RV enlargement and dysfunction.
区域性右心室（RV）功能障碍（RRVD）是急性肺栓塞（PE）的一种超声心动图特征，主要见于中重度RV功能障碍患者。本研究通过评估RRVD与血栓负荷及生物标志物的关系，探讨其临床重要性。我们纳入了1999年至2014年间因疑似急性PE入住急诊科并接受计算机断层血管造影、超声心动图及生物标志物检测（肌钙蛋白和NT-proBNP）的连续患者。RRVD定义为心尖运动正常，而与之对比的是中间游离壁节段运动减弱。RV评估包括心室尺寸测量、面积变化分数、游离壁纵向应变及三尖瓣环平面收缩期位移。采用改良米勒评分评估血栓负荷。在纳入的82例患者中，51例患有急性PE（平均年龄66±17岁，43%为男性）。无患者发生RV心肌梗死。41%的PE患者存在RRVD，所有无PE患者均无RRVD。在PE患者中，86%有RRVD的患者为中心型或多叶型PE。有RRVD的患者中重度RV扩张（81%对30%，p<0.01）和功能障碍（86%对23%，p<0.01）的患病率更高。RRVD的PE患者肌钙蛋白水平有升高的强烈趋势（有RRVD的PE患者为38%，无RRVD的PE患者为13%，p=0.08），而NT-proBNP无显著差异（67%对73%，p=0.88）。RRVD在不同阅片者之间显示出良好的一致性（87%）。RRVD与急性PE中血栓负荷增加相关，且在中重度RV扩大和功能障碍患者中更为常见。
