Purpose. We aimed to assess changes in right ventricular (RV) parameters determined by three-dimensional speckle tracking imaging (3D-STI) before and after long-term acute pulmonary embolism (PE) treatment. Methods. We enrolled 23 patients with acute PE confirmed by multidetector row chest computed tomography. 23 healthy subjects without signs of cardiopulmonary dysfunction served as a control group. Conventional echo RV parameters included tricuspid annular plane systolic excursion (TAPSE), myocardial performance index (RV-MPI) and RV fractional area change (RV-FAC). Pulmonary arterial systolic pressure was obtained by standard Doppler methods. Pulmonary hypertension was defined as a pulmonary artery systolic pressure of 40 mmHg or greater. RV end-diastolic and end-systolic volumes were measured from three-dimensional echocardiographic datasets and right ventricular ejection fraction (3D-RVEF) was calculated. 3D-STI was used to determine RV peak systolic strain, time to peak-systolic strain from the onset of QRS, standard deviation of the time to peak-systolic strain, and global area strain (RV-GAS). RV dyssynchrony was defined as the standard deviation of the six time to peak systolic strain values. Global longitudinal strain (RV-GLS) was calculated by averaging local strains along the entire right ventricle. Data analysis was performed offline using the original raw data from all 3DE data sets on a software workstation for semiautomated endocardial surface detection (EchoPAC BT11, 4D Auto LVQ, GE Vingmed Ultrasound, Horten, Norway). Results. Mean percentage intraobserver variability was 8% for RV-GLS and 6% for RV-GAS, and mean percentage interobserver variability was 11% for RV-GLS and 8% for RV-GAS. TAPSE, RV-MPI, RV-FAC (p<0.005) and RV-GAS (p<0.0001) were lower in patients with PE and pulmonary hypertension compared to the control group. A significant correlation was found between RV-GAS and pulmonary artery systolic pressure (r = 0.76, p <0.001), between RV-GAS and RV dyssynchrony (r = 0.71, p <0.005), and between RV-GAS and RV-GLS (r = 0.68, p <0.005). Decreased RV-GAS (<25%) and 3D-RVEF (< 45%) persisted in 5/23 pts after one month of medical treatment and in 4/23 pts after one year. By multivariate analysis, 3D-RVEF (p=0.03) and RV-GAS (p=0.008) were predictive of pulmonary arterial hypertension. Conclusions. Our findings show that acute PE has a significant impact on RV function as assessed by 3D-STI. 3D-RVEF and RV-GAS correlate with pulmonary hypertension and abnormal values may persist long-term during the pts follow-up.
Three-dimensional STI assessment of right ventricular function in acute cor pulmonale / Capotosto, Lidia; Dettori, Olga; Truscelli, Giovanni; Caranci, Fiorella; D'Angeli, Ilaria; Valentina De, Cicco; Melissa De, Maio; Pasqualina, Bruno; Francesco, Barillà; Vitarelli, Antonino. - In: EUROPEAN HEART JOURNAL. CARDIOVASCULAR IMAGING. - ISSN 2047-2404. - STAMPA. - 13(suppl-1):(2012), pp. i30-i31. (Intervento presentato al convegno EUROECHO & other Imaging Modalities 2012 tenutosi a Athens, Greece nel 2012) [10.1093/ehjci/jes248].
Three-dimensional STI assessment of right ventricular function in acute cor pulmonale
CAPOTOSTO, LIDIA;DETTORI, OLGA;TRUSCELLI, GIOVANNI;CARANCI, FIORELLA;D'ANGELI, ILARIA;VITARELLI, Antonino
2012
Abstract
Purpose. We aimed to assess changes in right ventricular (RV) parameters determined by three-dimensional speckle tracking imaging (3D-STI) before and after long-term acute pulmonary embolism (PE) treatment. Methods. We enrolled 23 patients with acute PE confirmed by multidetector row chest computed tomography. 23 healthy subjects without signs of cardiopulmonary dysfunction served as a control group. Conventional echo RV parameters included tricuspid annular plane systolic excursion (TAPSE), myocardial performance index (RV-MPI) and RV fractional area change (RV-FAC). Pulmonary arterial systolic pressure was obtained by standard Doppler methods. Pulmonary hypertension was defined as a pulmonary artery systolic pressure of 40 mmHg or greater. RV end-diastolic and end-systolic volumes were measured from three-dimensional echocardiographic datasets and right ventricular ejection fraction (3D-RVEF) was calculated. 3D-STI was used to determine RV peak systolic strain, time to peak-systolic strain from the onset of QRS, standard deviation of the time to peak-systolic strain, and global area strain (RV-GAS). RV dyssynchrony was defined as the standard deviation of the six time to peak systolic strain values. Global longitudinal strain (RV-GLS) was calculated by averaging local strains along the entire right ventricle. Data analysis was performed offline using the original raw data from all 3DE data sets on a software workstation for semiautomated endocardial surface detection (EchoPAC BT11, 4D Auto LVQ, GE Vingmed Ultrasound, Horten, Norway). Results. Mean percentage intraobserver variability was 8% for RV-GLS and 6% for RV-GAS, and mean percentage interobserver variability was 11% for RV-GLS and 8% for RV-GAS. TAPSE, RV-MPI, RV-FAC (p<0.005) and RV-GAS (p<0.0001) were lower in patients with PE and pulmonary hypertension compared to the control group. A significant correlation was found between RV-GAS and pulmonary artery systolic pressure (r = 0.76, p <0.001), between RV-GAS and RV dyssynchrony (r = 0.71, p <0.005), and between RV-GAS and RV-GLS (r = 0.68, p <0.005). Decreased RV-GAS (<25%) and 3D-RVEF (< 45%) persisted in 5/23 pts after one month of medical treatment and in 4/23 pts after one year. By multivariate analysis, 3D-RVEF (p=0.03) and RV-GAS (p=0.008) were predictive of pulmonary arterial hypertension. Conclusions. Our findings show that acute PE has a significant impact on RV function as assessed by 3D-STI. 3D-RVEF and RV-GAS correlate with pulmonary hypertension and abnormal values may persist long-term during the pts follow-up.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
