Right ventricular function assessment by 3D echocardiography and 2D speckle-tracking imaging in acute pulmonary embolism

Abstract

Objective: To assess changes in right ventricular (RV) function parameters determined by three-dimensional (3D) echocardiography and two-dimensional (2D) speckle-tracking echocardiography in patients with acute pulmonary embolism without systemic hypotension, as compare to a control population. Subject and method: Fifty-seven intermediate-high risk pulmonary embolism patients were prospectively studied at the onset of the acute episode and after median follow-up periods of 30 days. A control group of age-and sex-matched subjects were selected. All patients and the controls underwent 2D and 3D transthoracic echocardiography within 24 hours of pulmonary embolism diagnosis and one month after hospital discharge. Tricuspid annular peak systolic velocity (s’), tricuspid annular plane systolic excursion (TAPSE), RV diameter, RV fractional area change (FAC), 3D RV ejection fraction (EF), 2D RV global strain and RV free wall strain were measured. Result: From Dec. 2019 to March 2022, fifty-seven patients with acute intermediate-high risk of early mortality PE were included. Mean age was 56 ± 14 years. Men accounted for 47.4% (27/57). Control group consisted of 34 subjects. Pulmonary embolism patients initially had RV dysfunction as assessed by 2D and 3D parameters: RV diameter: 29.3 ± 4.6mm; TAPSE: 14.6 (9.1-15.7) mm; FAC: 31.5 (30.5-39.9)%; 3DRVEFL 31.9 ± 7.7%; RVGS: -9.8 ± 3%, RVFWS: -8.9 ± 3.3%. At 30-day follow-up: s’, TAPSE, RV diameter, RV FAC were restored compared to the control group, systolic pulmonary artery pressures decreased significantly, right atrial pressure, also decreased significantly at follow-up, contrary to 3DRVEF and RV 2D global strain and free wall strain. Conclusion: After 1 month of anticoagulant therapy in patients with intermediate-high risk pulmonary embolism, RV function has not fully recovered as assessed by 3D RVEF and 2D strain imaging, while the traditional echocardiographic assessment could not detect this incomplete recovery. Further studies are needed to assess the prognostic role and implications of this residual 3DRVEF and 2D RV strain impairment after PE.