Abstract 2107: Prediction of Cardiac Events in Chronic Pulmonary Thromboembolism by Right Ventricular Diastolic Dysfunction Assessed by Pulsed Tissue Doppler Imaging
Purpose: Right ventricular (RV) dysfunction is an important cause of mortality in patients with chronic pulmonary thromboembolism (CPTE) and elevated plasma brain natriuretic peptide (BNP) is also associated with poor prognosis. We evaluated whether RV diastolic dysfunction assessed by pulsed tissue doppler imaging (TDI) may predict cardiac events in patients with CPTE considering BNP levels.
Materials and methods: In 63 consecutive patients with CPTE, early diastolic myocardial velocity (Ea) at the tricuspid annulus and early diastolic tricuspid inflow (E) were obtained from 4-chamber views using TDI (Aplio 80, SSA-770A, Toshiba) and E/Ea was calculated as a parameter of RV diastolic dysfunction. BNP and other echo parameters, including estimated pulmonary arterial systolic pressure (PASP) and cardiac output (CO) were also obtained. A cardiac event (rehospitalization caused by congestive heart failure [CHF] or cardiac death) was the study end point. A 374±451day follow-up period was performed and the incidence of cardiac events was evaluated.
Results: E/Ea was significantly positively correlated with BNP (r=0.48, p<0.001). In the follow-up period, ten patients had cardiac events (11 with rehospitalization caused by CHF and one with cardiac death). We divided patients into group A with cardiac events (12 subjects) and group B without events (51 subjects). There were no significant differences in estimated PASP and CO between the groups. But serum BNP and E/Ea suggesting RV diastolic dysfunction were significantly higher in group A than in group B (221±191 vs 121±140mg/dl p<0.05 and 8.3±4.1vs 5.7±2.6 p<0.01, respectively). A logistic regression model for predicting cardiac events was constructed using age, male sex, estimated PASP, CO, BNP and E/Ea. In the model, E/Ea was associated with an increased incidence of cardiac events (relative risk>1.33, 95%CI 1.00–1.75).
Conclusion: E/Ea obtained by TDI, suggesting RV diastolic dysfunction, may predict cardiac events in patients with CPTE.