Factors associated with restoration of the right ventricle function according to 2D-speckle-tracking echocardiography in patients with acute pulmonary embolism

S.M. Sukhova

Abstract


Background. The purpose was to investigate the possible relation between anamnestic, instrumental and laboratory indicators and restoration of right ventricular (RV) function according to 2D speckle tracking echocardiography (2D STE) in patients with acute pulmonary embolism (PE) in the dynamics of treatment. Materials and methods. The study involved 104 patients with acute PE. All patients were examined using 2D STE, indicators were assessed on the first day of hospital stay and after 3 months of anticoagulant therapy (ACT), which was prescribed during hospitalization by envelope method: rivaroxaban or warfarin. After ACT and according to 2D-STE, residual RV dysfunction has been determined as a segmental ejection fraction of the apical RV segment less than 65 %, and the global longitudinal strain of the free RV wall is less than 18.5 %. Results. After ACT, all the examined patients were divided into two groups: group I included 13 (12.5 %) persons with residual RV dysfunction, group II consisted of 91 (87.5 %) patients with complete restoration of RV function. It was found that type 2 diabetes mellitus (p = 0.04) and chronic cardiac or respiratory failure (p = 0.03) were significantly more likely in the group I; an increase in troponin I (p = 0.05), creatinine (p = 0.009) and fibrinogen (p = 0.05) levels were noted, as well as a decrease in the glomerular filtration rate (p = 0.02) to less than 60 ml/min/1.73 m2. Among patients in group II, significantly more persons received rivaroxaban (p = 0.007), and in the group I — warfarin (p = 0.006). The median of the period from the PE episode to the ACT initiation was 9.0 days in second group and 20.0 days in the first group, p = 0.03. Conclusions. After three months of ACT, residual RV dysfunction remains in 12.5 % of patients with acute PE according to 2D STE. Accor­ding to the regression analysis, in 62.6 % of cases this failure was determined by the presence of such factors, as warfarin therapy, the treatment start date more than 9 days, the presence of type 2 diabetes mellitus and a decrease in the glomerular filtration rate to less than 60 ml/min/1.73 m2.

Keywords


pulmonary embolism; 2D-speckle-tracking echocardiography; right ventricular dysfunction; effectiveness of treatment

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DOI: https://doi.org/10.22141/2224-0586.6.85.2017.111613

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