Abstract 14629: Quantitative Assessment of Right Ventricular Function and Precise Characterization of Mcconnell Sign in Patients with Acute Pulmonary Thromboembolism Using Speckle-tracking Strain Imaging
This study sought to assess global and regional right ventricular (RV) function and to characterize an abnormal regional pattern known as McConnell sign specific to acute RV pressure overload from acute pulmonary thromboembolism (APTE) using speckle-tracking strain imaging by comparing with chronic pulmonary hypertension (CPH). Twenty-seven patients with massive or submassive APTE, 27 patients with CPH, and 27 age matched normal subjects (Control) were examined by speckle-tracking strain echocardiography from apical 4 chamber view. Global and 6-segmental longitudinal RV peak systolic strain was defined as an index of RV myocardial systolic shortening. We also calculated regional timing of peak systolic strain from the onset of QRS (time-to-peak systolic strain) normalized by RR interval. Twenty patients (74%) had a visually positive McConnell sign in patients with APTE (APTE-MC). Both APTE and CPH had reduced global peak systolic strain compared with Control. RV segments and apical septum were reduced in both APTE and CPH compared with Control; in particular, APTE-MC had pronouncedly reduced peak systolic strain in the mid RV wall compared with CPH (APTE-MC: -10 ± 8%*†, CPH: -16 ± 8%*, Control: -30 ± 6%, *p<0.05 vs. Control, †p<0.05 vs. CPH). Time-to-peak systolic strain in the mid RV wall was delayed in both APTE-MC and CPH compared with Control (APTE-MC: 542 ± 93 msec*, CPH: 502 ± 82msec*, Control: 445 ± 55msec, *p<0.05 vs. Control). In contrast, time-to-PSS in the apical RV wall in APTE-MC was similar to Control but was significantly delayed in CPH (APTE-MC: 377 ± 94msec, CPH: 462 ± 97msec*, Control: 433 ± 63msec, *p<0.05 vs. Control). In conclusion, speckle-tracking strain echocardiography effectively quantified global and regional RV function in patients with APTE and CPH. Both the normal timing of apical RV peak systolic shortening and severe hypokinesia in adjacent mid RV wall motion may be associated with visually preserved apical RV wall motion in patients with APTE and a positive McConnell sign.
- © 2010 by American Heart Association, Inc.