Regional Right Ventricular Dysfunction Detected by Echocardiography in Acute Pulmonary Embolism
Section snippets
METHODS
Patients: A total of 126 patients were studied retrospectively: a “training” cohort of 41 patients (group 1) and a separate “validation” cohort of 85 patients (group 2). Group 1 included 14 hemodynamically stable patients studied within 24 hours of the diagnosis of acute pulmonary embolism (part of 2 multicenter randomized trials4, 7) with RV dysfunction, 9 patients with a diagnosis of primary pulmonary hypertension and RV dysfunction, and 18 patients referred for atypical chest pain with
RESULTS
Quantitative analysis: Centerline analysis of group 1 revealed a distinct pattern of segmental RV wall motion in acute pulmonary embolism (Fig. 2). Patients with pulmonary embolism had near-normal RV free wall excursion at the most apical segments (5.7 ± 0.8 mm [mean ± SEM] for pulmonary embolism vs 6.2 ± 0.7 mm for normal at segment 40, p = NS). However, wall motion was markedly decreased in the mid-free wall segments (−0.2 ± 0.8 mm for pulmonary embolism vs 6.3 ± 0.7 mm for normal at segment
DISCUSSION
This study demonstrates that among patients with acute pulmonary embolism and RV dysfunction, there is a distinct, regional pattern of abnormal RV wall motion. Both quantitative and qualitative analyses of 2-dimensional echocardiograms in patients with acute pulmonary embolism revealed normal wall motion of the RV apex but akinesia of the mid-RV free wall. This echocardiographic pattern was both sensitive and specific for the diagnosis of acute pulmonary embolism in hospitalized patients with
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