P2766Increased right ventricular burden in patients with chronic thromboembolic disease

Abstract

Abstract Introduction Patients with chronic thromboembolic disease (CTED) have residual perfusion defects after pulmonary embolism (PE) but not increased pulmonary artery (PA) pressure. These patients suffer from functional limitation and have a higher risk of venous thromboembolism recurrence. Purpose In this study we wanted to explore if CTED patients had signs of increased PA pressure and right heart burden by echocardiography Methods Inclusion criteria were history of PE, age 18–75 years and PE diagnosed 6–72 months prior to inclusion. Patients with left ventricular systolic or diastolic heart failure, valvular disease, chronic pulmonary disease and chronic thromboembolic pulmonary hypertension were excluded. All patients underwent echocardiography with standard and novel methods and ventilation/perfusion (VQ)-scan. The echocardiographic examinations were blinded to the result of the VQ-scan. VQ-scan were analyzed according to the European Association of Nuclear Medicine-criteria, and deemed either positive or negative. Data are presented as mean ± SD or median ± IQR as appropriate. Independent sample t-test or Mann-Whitney U test was used for the primary statistical analysis. Multiple linear regression was used to adjust for age, BMI and systolic blood pressure. Results Table 1 VQ negative (n=58) VQ positive (n=20) p-value Adjusted Age (years) 59±8 67±6.5 0.71 Time since PE event (months) 37±19 33±17 0.42 Pulmonary artery acceleration time (ms) 145±22 119.5±26 <0.001 <0.001 Pulmonary artery diameter (mm) 21±3.3 25±3.6 <0.01 <0.01 TAPSE (mm) 25.7±3.6 24.9±4.0 0.45 RV (right ventricle) S' (cm/s) 12.7±2.3 12.8±2.7 0.78 RV isovolumic relaxation time (ms) 33±23.9 50±22 <0.01 <0.01 RV myocardial performance index 0.36±0.10 0.44±0.15 0.04 0.02 Tricuspid regurgitation maximum velocity (m/s) 2.3±0.3 2.7±0.4 <0.001 <0.001 LV (left ventricle) ejection fraction (%) 62.5±4.2 61.3±6.0 0.41 E/A 1.02±0.26 0.90±0.23 0.09 E/e' 6.8±2.0 6.5±2.2 0.75 E/A: ratio between transmitral pulsed doppler peak early (E) diastolic and atrial (A) velocity; E/e': ratio between E and peak early velocity (e') by tissue velocity. Figure 1 (error bars - mean and 95% CI) Conclusion Patients with CTED after PE have increased PA pressure and impaired RV systolic and diastolic function compared to those without residual perfusion defects. These findings indicate that CTED patients should be more thoroughly followed up.