Transthoracic echocardiography in pulmonary embolism: A diagnostic dilemma

Abstract

It was with great interest that we read the paper by Mansencal et al. [1] on diagnostic value of transthoracic echocardiography in patients with pulmonary embolism (PE). Although echocardiography with venous ultrasonography was accurately failed in distal PE, this combined method may facilitate the diagnostic value in proximal or lobar PE, particularly when severe PE is suspected. Really, the assessment of function of right ventricle (RV) is still a difficult puzzle because of the complicated geometry of the RV [2]. However, the function of RV is particularly difficult to assess non-invasively [3]. Although it remains unclear whether echocardiographic RV dysfunction is a prevalent and reliable predictor in patients with acute PE. Failure of the RV can often be visualized by 2dimensional echocardiography in patients with submassive PE. Furthermore, echocardiographically assessed RV dysfunction is gradually applied to guide for progression with therapy in patients with PE [3]. It is known that the mid-segment of RV free wall in PE is showed severe hypokinesia, with a normal contraction of the apical segment (McConnell sign) [4]. The evaluation of regional RV function by ultrasound remains a challenge. As a new method, easily and quickly obtainable non-invasive tissue Doppler parameter reflects depressed RV contractile function [5]. Recently, strain analysis is used to demonstrate