Right ventricular function in acute pulmonary embolism: a combined assessment by three-dimensional and speckle tracking echocardiography

Background. We aimed to assess changes in right ventricular (RV) parameters determined by three-dimensional echocardiography (3DE) and speckle tracking echocardiography (STE) in patients with acute pulmonary embolism and RV dysfunction without systemic hypotension (submassive PE). Methods. We prospectively studied 66 patients at the onset of the acute episode and after a median follow-up of 30 days and six months. Sixty-six controls were selected. RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE) and myocardial performance index (MPI) were determined. RV systolic pressure (RVSP) was assessed by continuous wave Doppler echocardiography. Three-dimensional right ventricular ejection fraction (3D-RVEF) was calculated. Two-dimensional peak systolic RV longitudinal strain (RVLS) was measured in the basal, mid and apical segments of free wall (BFW, MFW, AFW) and septum. Results. TAPSE and FAC were smaller and MPI was larger compared to controls (p<0.05). Global RVLS (p<0.05), MFW-RVLS (p<0.001), and 3D-RVEF (p<0.001) were lower in PE patients than controls. There was earlier reversal of MFW-RVLS values on a 30-day follow-up and longer reversal of 3D-RVEF and RVSP values on a 6-month follow-up. ROC analysis showed that changes in 3D-RVEF and MFW-RVLS were the most sensitive predictors of adverse events. By multivariate analysis, RVSP (p=0.007), MFW-RVLS (p=0.002) and 3D-RVEF (p=0.001) were independently associated with adverse outcomes. Conclusions. Acute submassive PE has a significant impact on RV function as assessed by 3DE and STE. Decrease in MFW-RVLS and 3D-RVEF may persist during short and long-term follow-up and correlate with unfavorable outcome.