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Abstract
Right ventricular dysfunction is a key point for the stratification of pulmonary embolism risk and affects therapeutic strategies. Longitudinal two dimensional (L2D) strain measure is a new technique for assessment of ventricular function. The aim of our study was to determine: 1) the inter-observer variability of right ventricular longitudinal 2D strain measure in the setting of emergency, and 2) whether longitudinal 2D strain may appropriately differentiate low risk pulmonary embolism patients with intermediate risk pulmonary embolism patients. Patients with low or intermediate risk pulmonary embolism were included in the study and underwent an echocardiogram at admission in the emergency department. Intermediate risk was defined by troponin elevation and/or echocardiographic right ventricular dysfunction, as recommended by European guidelines. An apical four-chamber view was recorded and analyzed off-line by two independent observers. Right ventricle was divided in six segments, lateral and septal wall being divided in basal, mid and apical region. L2D strain was calculated for each segment, and global L2D strain calculated for lateral wall, septal wall and the whole right ventricle. 28 patients were included, mean age 65 years, 13 with low risk and 15 with intermediate risk pulmonary embolism. Bland and Altman test showed a good inter-observer reproducibility. There was a significant difference between the intermediate and low risk patients for L2D strain of right ventricle (-13.3% vs -19.5%, p=0.0012), lateral wall (-12.1% vs -20.6%, p=0.0006) and septal wall (-14.5% vs -18.4%, p=0.05). A significant relation between L2D strain and right ventricular dilatation was observed (R 2 =0.187, p<0.0001). Right ventricle L2D strain is a reproducible technique and is potentially useful for the assessment of right ventricular function and stratification of risk of pulmonary embolism.
Published Version
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