Abstract 17012: Prognostic Value of Global and Regional Right Ventricular Strain and Dyssynchrony by Speckle Tracking Echocardiography in Acute Pulmonary Embolism: Comparison to Measures of RV function by Computed Tomography and Transthoracic Echocardiography
Background: Right ventricular (RV) strain and RV dyssynchrony measured by speckle tracking echocardiography (SPE) are altered in acute pulmonary embolism (PE). The prognostic utility of these measures have not been compared to conventional echocardiographic and computed tomography (CT) measures of RV dysfunction. We sought to determine the relative prognostic value of RV strain compared to that of CT RV/LV diameter ratio and conventional measures of RV dysfunction by transthoracic echocardiography (TTE).
Hypothesis: Global and regional RV strain by SPE will allow for improved risk stratification in acute PE.
Methods: 200 consecutive patients diagnosed with acute PE by CT pulmonary angiography who had a TTE within 48 hours were included. Global RV strain and regional RV strain in six segments (basal-, mid- and apical- free and septal walls, respectively) were measured using offline speckle tracking software. The standard deviation (SD) of the time to peak for the 6 segments was used to quantify RV dyssynchrony. The predictive ability (Area under the Curve; AUC) of the SPE measures of strain for PE-related mortality was compared to that of CT RV/LV ratio and TTE measures of RV dysfunction.
Results: Mean longitudinal strain was -18 +/-7.9 in the overall cohort. Regional strain was greatest in the basal lateral segment (-22 +/-14.9) and lowest in the apical septal segment (16.7 +/- 9.2). RV dyssynchrony was 92.9+/-67. There were 13 PE-related deaths. The predictive value of mean longitudinal strain (AUC = 0.64), basal RV free wall strain (AUC = 0.64) and mid RV free wall strain (AUC = 0.70) were not significantly different than that of CT RV/LV ratio, TTE RV/LV ratio and PASP by TTE (AUC 0.61, 0.64, and 0.65, respectively). Mid free wall strain had significantly better predictive value than dyssynchrony (AUC = 0.43, p< 0.05) and fractional area change by TTE (AUC = 0.45, p < 0.05).
Conclusion: Patterns of global and regional RV longitudinal strain and dyssynchrony are described. Although we showed that global and mid free wall RV strain by SPE has similar prognostic ability for PE-related death compared to conventional measures of RV dysfunction by CT and TTE, larger studies are required to confirm these findings.
- © 2013 by American Heart Association, Inc.