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Abstract
ABSTRACTObjective:To assess prognosis of pulmonary thromboembolism using tissue Doppler echocardiography and brain natriuretic peptide.Methods:Patients aged over 18 years were evaluated within 24 hours of confirmed diagnosis (chest tomography/pulmonary scintigraphy) of pulmonary embolism using two-dimensional echocardiography and tissue Doppler for right ventricular systolic (s') velocities, strain, tissue tracking and myocardial performance index. Plasma brain natriuretic peptide was also obtained within 24 hour. The influence of echocardiographic and clinical variables on mortality was examined (up to 12 months) using Cox regression analysis.Results:Out of 118 patients, 100 patients were included in the study (60 males, aged 55±17 years). Right ventricular dysfunction was observed in 28% using two-dimensional echocardiography. Tissue Doppler right ventricular variables (s' velocities, tissue tracking and strain) were decreased only for patients with right ventricular dysfunction, whereas myocardial performance index and systolic pulmonary artery pressure were increased. Mean brain natriuretic peptide value was 66±111pg/mL, also increased in patients with right ventricular dysfunction (136±146pg/mL). Mortality was 11% and related to age, malignancy and brain natriuretic peptide levels. The only echocardiographic variables capable of predicting events by univariate analysis were pulmonary pressure and right ventricular s' velocity. However, multivariate analysis showed only malignancy to predict mortality in this group.Conclusion:Lower tissue Doppler systolic velocities and elevated brain natriuretic peptide levels are associated with poorer prognosis in patients with pulmonary thromboembolism; but only malignancy emerged as an independent predictor of mortality.
Highlights
Mortality in pulmonary thromboembolism (PE) is essentially related to hemodynamic instability resulting from right ventricular dysfunction[1,2,3], requiring appropriate evaluation of this chamber
In regard to the B-type atrial natriuretic peptide (BNP), its importance for risk stratification is well-known for patients with heart failure, there is limited data regarding BNP and prognosis in PE[7,8]
Of the 100 patients studied, 28 showed right ventricular (RV) dysfunction according to the pre-established criteria: measurements of RV tissue Doppler (TD) variables were decreased only for patients with RV dysfunction; Myocardial performance index (MPI) and pulmonary artery systolic pressure were increased for these patients
Summary
Mortality in pulmonary thromboembolism (PE) is essentially related to hemodynamic instability resulting from right ventricular dysfunction[1,2,3], requiring appropriate evaluation of this chamber. Tissue Doppler (TD) can be used to complement the two-dimensional echocardiogram[4]. This methodology relies on the analysis of myocardial velocities to increase the sensitivity of the examination to detect myocardial dysfunction[5]. In regard to the B-type atrial natriuretic peptide (BNP), its importance for risk stratification is well-known for patients with heart failure, there is limited data regarding BNP and prognosis in PE[7,8]. Patients with PE and increased BNP seem to present a higher morbidity and mortality[7], but with a lower cutoff value (BNP
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