Echocardiography in assessing acute pulmonary hypertension due to pulmonary embolism

Abstract

Eighteen patients with acute pulmonary embolism were studied with right heart catheterization and M mode echocardiography. No patient had evidence of preexisting cardiopulmonary disease; pulmonary embolism was documented with pulmonary angiography. The mean pulmonary arterial pressure correlated with the angiographic severity index of embolic obstruction (r = 0.61, p <0.001). The size of the right pulmonary artery was evaluated with suprasternal echocardiography and corrected for body surface area (index size). In patients with elevated mean pulmonary arterial pressure (greater than 20 mm Hg) the index size was increased (mean ± standard error of the mean 15.1 ± 0.6 mm/m2, p <0.001) over values in a control group of 25 normal subjects with a mean normal pulmonary arterial pressure (9.6 ± 0.9 mm/m2) and in 5 patients with acute pulmonary embolism and a mean normal pulmonary arterial pressure (10.9 ± 0.4 mm/m2). For all measurements the index size of the right pulmonary artery correlated with the mean pulmonary arterial pressure (r = 0.84, p <0.001). Precordial echocardiography revealed that the right ventricular dimension was increased in 13 of 16 patients and the left ventricular dimension decreased in 10 of 15 patients. Thus, the right ventricular end-diastolic/left ventricular end-diastolic ratio was above normal in 14 of 15 patients when compared with the value in 25 normal subjects. This ratio correlated well with the angiographic severity index of embolic obstruction (r = 0.83, p <0.001). The E–F slope of the anterior mitral leaflet was reduced in 12 of 16 patients. In eight patients an abnormal pattern of septal motion was observed, exhibiting a posterior motion during diastole. Suprasternal and precordial echocardiography seems to be a valuable noninvasive technique in the assessment of acute pulmonary hypertension in patients with acute pulmonary embolism with no known prior cardio-pulmonary disorder. Eighteen patients with acute pulmonary embolism were studied with right heart catheterization and M mode echocardiography. No patient had evidence of preexisting cardiopulmonary disease; pulmonary embolism was documented with pulmonary angiography. The mean pulmonary arterial pressure correlated with the angiographic severity index of embolic obstruction (r = 0.61, p <0.001). The size of the right pulmonary artery was evaluated with suprasternal echocardiography and corrected for body surface area (index size). In patients with elevated mean pulmonary arterial pressure (greater than 20 mm Hg) the index size was increased (mean ± standard error of the mean 15.1 ± 0.6 mm/m2, p <0.001) over values in a control group of 25 normal subjects with a mean normal pulmonary arterial pressure (9.6 ± 0.9 mm/m2) and in 5 patients with acute pulmonary embolism and a mean normal pulmonary arterial pressure (10.9 ± 0.4 mm/m2). For all measurements the index size of the right pulmonary artery correlated with the mean pulmonary arterial pressure (r = 0.84, p <0.001). Precordial echocardiography revealed that the right ventricular dimension was increased in 13 of 16 patients and the left ventricular dimension decreased in 10 of 15 patients. Thus, the right ventricular end-diastolic/left ventricular end-diastolic ratio was above normal in 14 of 15 patients when compared with the value in 25 normal subjects. This ratio correlated well with the angiographic severity index of embolic obstruction (r = 0.83, p <0.001). The E–F slope of the anterior mitral leaflet was reduced in 12 of 16 patients. In eight patients an abnormal pattern of septal motion was observed, exhibiting a posterior motion during diastole. Suprasternal and precordial echocardiography seems to be a valuable noninvasive technique in the assessment of acute pulmonary hypertension in patients with acute pulmonary embolism with no known prior cardio-pulmonary disorder.