A new parameter for the determination of normal right ventricular function in patients with acute pulmonary embolism

Authors

Keywords:

Acute pulmonary embolism, Right ventricular function, Age, Heart rate, Oxygen saturation

Abstract

Background/Aim: The performance of the right ventricular myocardium is crucial in various pathological states and the right ventricular dysfunction has a prognostic value in pulmonary embolism. We sought to bring out which parameters were helpful in predicting a normal right ventricular function in patients with acute pulmonary embolism. Methods: Consecutive 100 acute pulmonary embolism patients, who were hospitalized and confirmed by computed tomography angiography, were enrolled in this cohort study. All patients’ demographics, symptoms on admission, risk factors, electrocardiography and laboratory findings, and hemodynamic parameters were assessed. Echocardiography was performed in the first 24 hours. The study group of pulmonary embolism patients was divided into two groups based on their basic characteristics: Patients with normal right ventricular function and patients with right ventricular failure. Results: The average age of the patients was 63 (16) years, with 48 (48%) of them being male. Twenty three patients (23%) had normal RV functions. According to the multiple logistic regression analysis, age (P=0.041, OR: 1.174, 95% CI: 1.007 to 1.368), oxygen saturation (P=0.026, OR: 1.372, 95% CI: 1.039 to 1.812) and heart rate (P=0.049, OR: 1.160, 95% CI: 1.001 to 1.346) were independent predictors of normal RV function. The setting in which all three parameters (Age, Heart rate, Oxygen saturation) were positive was considered AHO index=1, with a positive predictive value of 100% a sensitivity of 44%, a negative predictive value of 85.6% and a specificity of 100% (AUC: 0.717, 95% CI: 0.619 to 0.803) for normal RV function. Conclusion: In acute pulmonary embolism patients who were younger than 53 years of age with a heart rate of ≤118 bpm and an oxygen saturation of >90% (AHO index=1), right ventricular functions were normal. Accordingly, without the need of computed tomography angiography or echocardiography, the clinician may predict normal right ventricular function with available demographic and noninvasive hemodynamic parameters.

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References

Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J. 2019;54(3):1901647. doi: 10.1183/13993003.01647-2019.

Bougouin W, Marijon E, Planquette B, Karam N, Dumas F, Celermajer DS, et al. Pulmonary embolism related sudden cardiac arrest admitted alive at hospital: Management and outcomes. Resuscitation. 2017;115:135-40. doi: 10.1016/j.resuscitation.2017.04.019.

Hussain ST, Bartholomew JR, Leacche M, Zhen-Yu Tong M. Retrograde Pulmonary Embolectomy for Acute Pulmonary Embolism: A Simplified Technique. Ann Thorac Surg. 2017;103(5):473-74. doi: 10.1016/j.athoracsur.2016.11.082.

Larsen TB, Skjøth F, Kjældgaard JN, Lip GYH, Nielsen PB, Søgaard M. Effectiveness and safety of rivaroxaban and warfarin in patients with unprovoked venous thromboembolism: a propensity-matched nationwide cohort study. Lancet Haematol. 2017;4(5):237-44. doi: 10.1016/S2352-3026(17)30054-6.

Sokalskis V, Peluso D, Jagodzinski A, Sinning C. Added clinical value of applying myocardial deformation imaging to assess right ventricular function. Echocardiography. 2017;34: 919-27

Vamsidhar A, Rajasekhar D, Vanajakshamma V, Lakshmi AY, Latheef K, Siva Sankara C, et al. Comparison of PESI, echocardiogram, CTPA, and NT-proBNP as risk stratification tools in patients with acute pulmonary embolism. Indian Heart J. 2017;69(1):68-74. doi: 10.1016/j.ihj.2016.07.010.

Dursunoğlu N, Dursunoğlu D, Yıldız Aİ, Rota S. Evaluation of cardiac biomarkers and right ventricular dysfunction in patients with acute pulmonary embolism. Anatol J Cardiol. 2016;16(4):276-82. doi: 10.5152/akd.2014.5828.

Kucher N, Rossi E, De Rosa M, Goldhaber SZ. Prognostic role of echocardiography among patients with acute pulmonary embolism and a systolic arterial pressure of 90 mm Hg or higher. Arch Intern Med. 2005;165:1777–81.

Coutance G, Cauderlier E, Ehtisham J, Hamon M, Hamon M. The prognostic value of markers of right ventricular dysfunction in pulmonary embolism: a meta-analysis. Crit Care. 2011;15(2):R103. doi: 10.1186/cc10119

Sanchez O, Trinquart L, Colombet I, Durieux P, Huisman MV, Chatellier G, et al. Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: a systematic review. Eur Heart J. 2008;29:1569–77.

Becattini C, Agnelli G, Vedovati MC, Pruszczyk P, Casazza F, Grifoni S, et al. Multidetector computed tomography for acute pulmonary embolism: diagnosis and risk stratification in a single test. Eur Heart J. 2011;32:1657–63.

Becattini C, Vedovati MC, Agnelli G. Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation. 2007;116:427–33.

Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23:685-713.

Lancellotti P, Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C, et al; European Association of Echocardiography. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr. 2010;11:307–32.

Yock PG, Popp RL. Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation. 1984;70:657–62.

Zorlu A, Yucel H, Bektasoglu G, Turkdogan KA, Eryigit U, Sarikaya S, Ege MR, Tandogan I, Yilmaz MB. Increased γ-glutamyl transferase levels predict early mortality in patients with acute pulmonary embolism. Am J Emerg Med. 2012;30:908-15.

Zorlu A, Bektasoglu G, Guven FM, Dogan OT, Gucuk E, Ege MR, Altay H, Cinar Z, Tandogan I, Yilmaz MB. Usefulness of admission red cell distribution width as a predictor of early mortality in patients with acute pulmonary embolism. Am J Cardiol. 2012;109:128-34.

Ozsu S, Çoşar AM, Aksoy HB, Bulbul Y, Oztuna F, Karahan SC, Ozlu T. Prognostic Value of Uric Acid for Pulmonary Thromboembolism. Respir Care. 2017;62:1091-96.

Qian HY, Huang J, Yang YJ, Yang YM, Li ZZ, Zhang JM. Heart-type Fatty Acid Binding Protein in the Assessment of Acute Pulmonary Embolism. Am J Med Sci. 2016;352:557-62.

Vuilleumier N, Simona A, Méan M, Limacher A, Lescuyer P, Gerstel E, et al. Comparison of Cardiac and Non-Cardiac Biomarkers for Risk Stratification in Elderly Patients with Non-Massive Pulmonary Embolism. PLoS One. 2016 24;11(5):e0155973. doi: 10.1371/journal.pone.0155973.

McIntyre KM, Sasahara AA. The hemodynamic response to pulmonary embolism in patients without prior cardiopulmonary disease. Am J Cardiol. 1971;28:288-94.

Smulders YM. Pathophysiology and treatment of haemodynamic instability in acute pulmonary embolism: the pivotal role of pulmonary vasoconstriction. Cardiovasc Res. 2000;48:23-33.

Delcroix M, Mélot C, Lejeune P, Leeman M, Naeije R. Effects of vasodilators on gas exchange in acute canine embolic pulmonary hypertension. Anesthesiology. 1990;72:77-84.

Huet Y, Brun Buisson C, Lemaire F, Teisseire B, Lhoste F, Rapin M. Cardiopulmonary effects of ketanserin infusion in human pulmonary embolism. Am Rev Respir Dis. 1987;135:114-7.

Marcus JT, Gan CT, Zwanenburg JJ, Boonstra A, Allaart CP, Götte MJ, et al. Interventricular mechanical asynchrony in pulmonary arterial hypertension: left-to-right delay in peak shortening is related to right ventricular overload and left ventricular underfilling. J Am Coll Cardiol. 2008;51:750-7.

Goldhaber SZ, Haire WD, Feldstein ML, Miller M, Toltzis R, Smith JL, et al. Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion. Lancet 1993;341:507-11.

Kreit JW. The impact of right ventricular dysfunction on the prognosis and therapy of normotensive patients with pulmonary embolism. Chest. 2004;125:1539-45.

Henzler T, Roeger S, Meyer M, Schoepf UJ, Nance JW Jr., Haghi D, et al. Pulmonary embolism: CT signs and cardiac biomarkers for predicting right ventricular dysfunction. Eur Respir J. 2012;39:919-26.

Klok FA, Mos IC, Huisman MV. Brain-type natriuretic peptide levels in the prediction of adverse outcome in patients with pulmonary embolism: a systematic review and meta-analysis. Am J Respir Crit Care Med. 2008;178:425-30.

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Published

2021-09-01

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Research Article

How to Cite

1.
Kerkütlüoğlu M, Güneş H, Yücel O, Doğan Ömer, Yılmaz MB. A new parameter for the determination of normal right ventricular function in patients with acute pulmonary embolism. J Surg Med [Internet]. 2021 Sep. 1 [cited 2022 Nov. 28];5(9):950-3. Available from: https://jsurgmed.com/article/view/984512