Rascón-Sabido R, García MRC, Carrillo-Estrada M, Arenas-Fonseca JG, Martínez-Hernández C, Ibarra-Quevedo D, Almeida-Gutiérrez E

Language: Spanish
References: 16
Page: 5-15
PDF size: 247.85 Kb.

ABSTRACT

Introduction: Acute pulmonary embolism (PE) is a serious condition. Tridimensional Ecocardiography (3D ECHO) is an accessible, novel and accurate method for determination of right ventricular and atrial function. To date there are insufficient studies to assess their role in this entity. Objective: Determine the usefulness of ECO-3D in evaluating right atrial and ventricular function, and the risk of cardiovascular complications in patients with acute PE. Material and methods: 35 patients were admitted to the HC CMN SXXI with PE by CT angiogram, we analized 2D and 3D parameters by Philips iE33, right atrial and ventricular function (TomTec and QLAB 10). Hospital cardiovascular complications were evaluated. Results: The relative risk of major combined cardiovascular events for 3D ECHO was: right atrial sphericity index › 1.32; RR 20.3 95% CI 2.9-13.8; p = 0.0001, RVEF RR 7.3 95% CI 2.5-20.9; p = 0.0001, RVEDV› 77 mL RR 2.56 95% CI 7.3-20.9, p = 0.0001, RR 5.5 RVESV 95% CI 2.26-13.3; p = 0.0001. Multivariate analysis showed three independent risk predictors: right atrial sphericity index › 1.32, massive PE and mean arterial pressure. Conclusions: The combined assessment by 3D echocardiography right ventricular and atrial function allow a quantitative assessment, risk prediction for cardiovascular complications and presentation of time-hospital stay in patients with acute PE.

REFERENCES

1. Torbicki A, Perrier A, Konstantinides S et al. Guidelines on the diagnosis and management of acute pulmonary embolism. European Heart Journal. 2008; 29 (18): 2276-2315.

2. Jiménez OE, Velázquez-Lupiañez L, Martínez RP. Tromboembolismo pulmonar en atención primaria. Semergen. 2012; 38 (1): 1-4.

3. Jaff MR, McMurtry S, Archer SL et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis and chronic thromboembolic pulmonary hypertension: A scientific statement from de American Heart Association. Circulation. 2011; 123 (16): 1788-1830.

4. Jerjes-Sánchez C, Elizalde-González JJ, Sandoval Zárate J et al. Diagnóstico, estratificación y tratamiento de la tromboembolia pulmonar aguda. Guías y Recomendaciones del Capítulo de Circulación Pulmonar de la Sociedad Mexicana de Cardiología. Arch Cardiol Mex. 2004; 74 (3): 547-585.

5. McIntyre KM, Sasahara AA. The ratio of pulmonary arterial pressure to pulmonary vascular obstruction: index of preembolic cardiopulmonary status. Chest. 1977; 71 (6): 354-359.

6. Wolde M, Söhne M, Quak E et al. Prognostic value of echocardiographically assessed right ventricular dysfunction in patients with pulmonary embolism. Arch Intern Med. 2004; 164 (15): 1685-1689.

7. Dell‘Italia LJ. The right ventricle: anatomy, physiology and clinical importance. Curr Prob Cardiol. 1991; 16: (10): 653-720.

8. Rudski LD, Lai WW, Afilalo J, Hua L et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2010; 23 (7): 685-713.

9. Niemann PS, Pinho L, Balbach T et al. Anatomically oriented right ventricular volume measurements with dynamic three dimensional echocardiography validated by 3 - Tesla Magnetic Resonance Imaging. J Am Coll Cardiol. 2007; 50 (17): 1668-1676.

10. Vtarelli A, Barillà F, Cpotosto L et al. Right ventricular function in Acute pulmonary embolism: A combined assessment by three-dimensional and speckle - tracking echocardiography. J Am Soc Echocardiogr. 2014; 27 (3): 329-338.

11. Grapsa J, Gibbs SR, Cabrita IZ et al. The association of clinical outcome with right atrial and ventricular remodelling in patients with pulmonary arterial hypertension: study with real time three dimensional echocardiography. Eur Heart J Cardiovasc Imaging. 2012; 13 (8): 666-672.

12. Vitarelli A. Echocardiography, troponins and lower extremity ultrasound: the Three Musketeers lead the prognosis of acute pulmonary embolism. Thorax. 2011; 66: 2-4.

13. Watts JA, Marchick MR, Kline JA. Right ventricular heart failure from pulmonary embolism: key distinctions from chronic pulmonary hypertension. J Card Fail. 2010; 16: 250-259.

14. van der Bijl N, Klok FA, Huisman MV et al. Measurement of right and left ventricular function by ECG-synchronized CT scanning in patients with acute pulmonary embolism: usefulness for predicting short-term outcome. Chest. 2011; 140: 1008-1015.

15. Pavlicek M, Wahl A, Rutz T. Right ventricular systolic function assessment: rank of echocardiographic methods vs. cardiac magnetic resonance imaging. European Journal of Echocardiography 2011;12: 871–80.

16. Klok FA, Romeih S, Kroft LJ et al. Recovery of right and left ventricular function after acute pulmonary embolism. Clin Radiol. 2011; 66: 1203-1207.