ISSN 2996-8215
International Journal of Cardiology | Vol. 4, No. 6, June 2013 | pp. 41–48
DOI: 10.46882/2013/IJC/000051
Original Research Article
Prognostic Value of Right Ventricular Global Longitudinal Strain in Patients with Acute Pulmonary Embolism
Hans-Jürgen Schmidt¹, Werner Müller¹, Dieter Reinhardt²
¹Department of Cardiology and Pulmonology, Charité – Universitätsmedizin Berlin, Berlin, Germany
²Division of Vascular Medicine, University Hospital Leipzig, Leipzig, Germany
Abstract:
Acute pulmonary embolism (PE) frequently causes acute right ventricular (RV) overload and failure, which directly determines short-term mortality. Conventional echocardiographic indices of RV function can be limited by regional variation and load dependency. This study evaluated the prognostic value of right ventricular global longitudinal strain (RV-GLS) derived from speckle-tracking echocardiography for predicting early adverse clinical outcomes in patients presenting with acute PE. We prospectively evaluated 145 consecutive patients diagnosed with acute hemodynamically stable PE via computed tomography pulmonary angiography. Standard and speckle-tracking echocardiography were performed within 24 hours of admission to measure tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC), and RV-GLS. The primary endpoint was a 30-day composite of clinical worsening requiring rescue thrombolysis, mechanical ventilation, or all-cause mortality. The primary endpoint occurred in 22 patients (15.2%). Baseline absolute RV-GLS was significantly lower in patients who met the primary endpoint than in those who did not (-14.2% ± 2.6% vs. -21.4% ± 3.1%, p < 0.001). Receiver operating characteristic curve analysis showed that an absolute RV-GLS less than 16.5% predicted 30-day adverse events with a sensitivity of 86.4% and a specificity of 81.3%. Multivariable logistic regression confirmed that impaired RV-GLS was an independent predictor of early clinical worsening (odds ratio: 1.34 per 1% absolute strain decrease, 95% CI: 1.14–1.58, p = 0.001), outperforming both TAPSE and FAC. Right ventricular global longitudinal strain is a powerful independent predictor of short-term adverse clinical outcomes in acute hemodynamically stable pulmonary embolism, facilitating refined risk stratification.
Keywords: Pulmonary embolism, Right ventricular function, Speckle-tracking echocardiography, Longitudinal strain, Prognosis, Risk stratification
Received: March 04, 2013; Revised: April 18, 2013; Accepted: May 10, 2013; Published: June 15, 2013
Citation: International Journal of Cardiology, 2013, Vol. 4, No. 6, pp. 41–48, DOI: 10.46882/2013/IJC/000051