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Right ventricular speckle tracking strain echocardiography in patients with acute pulmonary embolism

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Abstract

Right atrial (RA) and right ventricular (RV) parameters assessed by traditional echocardiography lack sensitivity to identify pulmonary embolism (PE). We sought to determine if alterations in RV free wall longitudinal strain (FWS) would be present in PE patients and improve evaluation. This retrospective study comprised of 84 consecutive PE patients from 2 centres, with adequate transthoracic echocardiography (TTE) images for RV FWS analysis. PE patients were compared to 66 healthy controls. Compared to controls, PE patients had increased RV parasternal long-axis diameter (RVPLAX) (33.4 ± 5.8 mm vs 39.9 ± 4.1 mm) and RA area (17.4 ± 5.6 cm2 vs 14.5 ± 3.1 cm2) (p < 0.001 for both). RV function was reduced in PE patients (RV fractional area change 31.1 ± 13.2% vs 41.7 ± 9.1%, TAPSE 17.0 ± 4.5 vs 21.3 ± 2.2 mm; p < 0.001 for both). RV FWS was reduced in PE patients (−14.4 ± 7.2% vs − 26.0 ± 4.4%, p < 0.001). RV FWS was the best discriminator for PE (AUC 0.912). In comparative multiple logistic regression models for PE, the model which included traditional measures of RV size and function and RV FWS, produced a powerful classifier (AUC 0.966, SE 0.013) with significantly better performance (p < 0.022) than the model without RV FWS (AUC 0.921, SE 0.024). RV FWS is a discriminator of PE patients; addition of RV FWS to existing parameters of RV size and function, significantly improves sensitivity and specificity for diagnosis of PE, and may play a role in diagnosis and guiding therapy. Validation in other PE groups is required to confirm these observations and its prognostic value needs evaluation.

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Author notes

  1. Siddharth J. Trivedi and Andrew D. Terluk are equal first authors.

Authors and Affiliations

  1. Department of Cardiology, Westmead Hospital, Wentworthville, PO BOX 533, Sydney, NSW, 2145, Australia

    Siddharth J. Trivedi & Liza Thomas

  2. Westmead Clinical School, University of Sydney, Sydney, Australia

    Siddharth J. Trivedi, Andrew D. Terluk, Karen Byth & Liza Thomas

  3. Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, Australia

    Andrew D. Terluk

  4. Department of Cardiology, Liverpool Hospital, Sydney, Australia

    Andrew D. Terluk & Christian J. Mussap

  5. Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia

    Leonard Kritharides, Vincent Chow & Austin C. C. Ng

  6. Department of Cardiology, St George Hospital, Sydney, Australia

    Ee-May Chia

  7. South Western Sydney Clinical School, University of New South Wales, Sydney, Australia

    Ee-May Chia, Christian J. Mussap & Liza Thomas

  8. Research and Education Network, Western Sydney Local Health District, Sydney, Australia

    Karen Byth

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  1. Siddharth J. Trivedi
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Trivedi, S.J., Terluk, A.D., Kritharides, L. et al. Right ventricular speckle tracking strain echocardiography in patients with acute pulmonary embolism. Int J Cardiovasc Imaging 36, 865–872 (2020). https://doi.org/10.1007/s10554-020-01779-8

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