Функциональное состояние миокарда правого желудочка у пациентов с острой тромбоэмболией легочной артерии до и после тромболитической терапии

Abstract

We present in this paper results of assessment of functional state of right ventricular (RV) myocardium in 38 patients with acute pulmonary embolism (PE) before and after endovascular recanalization of pulmonary arteries supplemented with thrombolytic therapy. According to echocardiography data RV dysfunction was detected in 60.5% of cases, while an elevated concentration of brain natriuretic peptide (BNP) in blood plasma was observed in all patients. None of the patients had elevated level of troponin I. An increased concentration of BNP in blood plasma with normal troponin level in patients with acute PE was indicative of a hidden RV dysfunction due to its dilatation, acute volume or pressure overload without evidence of myocardial damage. Implications. All patients with acute pulmonary embolism who are hemodynamically stable, but have elevated levels of plasma BNP should undergo thrombolytic therapy (TLT) with the aim of early recanalization of pulmonary arteries and elimination of RV dysfunction. Early thrombolytic recanalization of the pulmonary arteries not only provides restoration of impaired RV function, but also prevents formation of post embolic chronic pulmonary hypertension and improves clinical prognosis.