ISSN 2996-8215
International Journal of Cardiology | Vol. 14, No. 8, August 2023 | pp. 57–64
DOI: 10.46882/2023/IJC/000172
Original Research Article
Short-Term Prognostic Efficacy of Right Ventricular Free-Wall Longitudinal Strain in Hemodynamically Stable Acute Pulmonary Embolism
Jean-Pierre Dubois¹, Pierre Vigneron¹, Lucia Rossi²
¹Department of Interventional Cardiology, Hôpital Européen Georges-Pompidou, Paris, France
²Department of Cardiac Surgery, University of Milan, Milan, Italy
Abstract:
Acute pulmonary embolism (PE) frequently causes acute right ventricular (RV) pressure overload, leading to acute failure and early mortality. Conventional echocardiographic parameters can be limited by angle dependency and regional loading. This study evaluated the short-term prognostic value of right ventricular free-wall longitudinal strain (RV-FWS) measured via speckle-tracking echocardiography in hemodynamically stable acute PE. We prospectively evaluated 140 consecutive patients diagnosed with acute hemodynamically stable PE confirmed by computed tomography angiography. Standard and speckle-tracking echocardiograms were performed within 24 hours of emergency admission to determine tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC), and absolute RV-FWS. The primary endpoint was a 30-day composite of clinical worsening requiring emergency rescue thrombolysis, mechanical ventilation, or all-cause mortality. The primary endpoint occurred in 21 patients (15.0%). Baseline absolute RV-FWS was significantly reduced in patients who met the primary endpoint compared to those who did not (-13.8% ± 2.4% vs. -21.2% ± 3.2%, p < 0.001). Receiver operating characteristic curves showed that an absolute RV-FWS less than 16.0% predicted 30-day adverse clinical events with a sensitivity of 85.7% and a specificity of 82.4%. Multivariable logistic regression confirmed that impaired absolute RV-FWS was an independent predictor of short-term adverse clinical outcomes (odds ratio: 1.32 per 1% absolute strain reduction, 95% CI: 1.12–1.55, p = 0.001), outperforming both TAPSE and FAC. Right ventricular free-wall longitudinal strain serves as a powerful independent predictor of short-term adverse outcomes in hemodynamically stable acute pulmonary embolism, facilitating refined emergency risk stratification.
Keywords: Pulmonary embolism, Right ventricular function, Speckle-tracking echocardiography, Longitudinal strain, Prognosis, Short-term mortality
Received: May 12, 2023; Revised: June 25, 2023; Accepted: July 11, 2023; Published: August 20, 2023