Association Between Right Ventricular Function and Perfusion Abnormalities in Hemodynamically Stable Patients With Acute Pulmonary Embolism
| Autor: | David Leibowitz, Shunichi Homma, Sam Das, Byron Thomashow, Thiruvengadam Anandarangam, Rachel L. Miller, Philip O. Alderson |
|---|---|
| Rok vydání: | 1998 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Pulmonary Circulation medicine.medical_specialty Ventricular Dysfunction Right Critical Care and Intensive Care Medicine Internal medicine medicine Humans cardiovascular diseases Radionuclide Imaging Lung Aged Cardiopulmonary disease business.industry Vascular disease Respiratory disease Hemodynamics Heparin Middle Aged medicine.disease Pulmonary embolism medicine.anatomical_structure Echocardiography Acute Disease cardiovascular system Cardiology Female Transthoracic echocardiogram Pulmonary Embolism Cardiology and Cardiovascular Medicine business Perfusion medicine.drug |
| Zdroj: | Chest. 113:665-670 |
| ISSN: | 0012-3692 |
| Popis: | Background/objectives Patients presenting with acute pulmonary embolism associated with hemodynamic compromise exhibit right ventricular enlargement and dysfunction on transthoracic echocardiogram. However, the degree of echocardiographic abnormalities among hemodynamically stable patients without preexisting cardiopulmonary disease during the acute stage of pulmonary embolism, and following treatment, is unknown. Therefore, this study was designed to assess the extent of right ventricular abnormalities detected on transthoracic echocardiogram in patients following acute pulmonary embolism and during treatment with anticoagulation or vena caval interruption. The extent of pulmonary vascular obstruction and complication rate on follow-up were also assessed. Design/interventions Sixty-four consecutive hemodynamically stable patients without preexisting known cardiopulmonary disorder presenting with acute pulmonary embolism and undergoing treatment with anticoagulation or inferior vena caval interruption were studied. All subjects underwent a two-dimensional transthoracic echocardiogram within 24 h of diagnosis. The degree of perfusion abnormality on lung scan was quantified. Twenty-six patients underwent follow-up echocardiogram and lung scan at 6 weeks. The echocardiographic findings were compared with those obtained from a group of normal control subjects matched for gender and age. Results Although the mean right ventricular end-diastolic areas did not differ (21.9±5.2 cm 2 vs 20.1±2.9 cm 2 for control subjects; p=not significant), the right ventricular end-systolic area was larger in comparison to our series of control subjects (14.6±5.1 cm 2 vs 11.7±2.0 cm 2 ; p=0.025). Fractional right ventricular area change was reduced in the patient group compared with the control subjects (34.3±9.0% vs 41.3±7.0%; p=0.003). The extent of right ventricular end-systolic area enlargement and decrease in fractional area change did not correlate with the degree of pulmonary vascular obstruction. Patients who were restudied at 6 weeks showed minimal improvement in echocardiographic findings, despite almost complete resolution of perfusion defects on lung scan. Conclusions The extent of right ventricular dysfunction in hemodynamically stable, previously normal patients with acute pulmonary embolism does not reflect the extent of the perfusion abnormalities. Further, right ventricular enlargement and systolic dysfunction are present and persistent despite treatment with heparin and warfarin therapy or vena caval interruption. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|