Turk Kardiyol Dern Ars. 2017; 45(8): 709-714 | DOI: 10.5543/tkda.2017.94694
The relationship between right ventricular outflow tract fractional shortening and Pulmonary Embolism Severity Index in acute pulmonary embolism
, Murat Karamanlıoğlu1
, Suzan Şahan2
, Murat Gül3
, Ahmet Korkmaz4
, Omaç Tüfekçioğlu21
Department of Cardiology, Atatürk Chest Disease and Thorasic Surgery Training and Research Hospital, Ankara Turkey2
Department of Cardiology, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey3
Department of Cardiology, Düzce State Hospital, Düzce, Turkey4
Department of Cardiology, Ankara Numune Training and Research Hospital, Ankara, Turkey
OBJECTIVE Right ventricular (RV) functions are clinically important in acute pulmonary embolism (APE). Measurement of systolic function of the right ventricular outflow tract (RVOT) with echocardiography is a simple method to evaluate RV function. The aim of this study was to determine the relationship between RVOT systolic function and the Pulmonary Embolism Severity Index (PESI).
METHODS A total of 151 patients diagnosed with APE by pulmonary computed tomography angiography or ventilation/perfusion scintigraphy were included. Patients were assigned to 2 groups based on the simplified PESI (sPESI): sPESI <1 (n=85) and sPESI ≥1 (n=66). RV conventional parameters, RVOT dimensions, and fractional shortening (RVOT-FS) were also measured.
RESULTS Mean age was similar between sPESI <1 and >1 patients (58.7±12.9 years vs. 61.1±12.7 years, respectively). Frequency of male gender was significantly higher in PESI <1 group (61.2% vs. 40.2%, p=0.013). No significant differences were found between the groups in fasting glucose, serum creatinine, hemoglobin, C-reactive protein, erythrocyte sedimentation rate, troponin, and D-dimer levels, and left ventricular ejection fraction. RVOT-FS was higher in patients with sPESI <1 than in patients with sPESI ≥1 (34.41±3.56 vs. 22.98±4.22), and this difference was significant (p<0.001). Tricuspid annular plane systolic excursion values were lower and pulmonary artery systolic pressure values were higher in the sPESI ≥1 group, which was also statistically significant (p<0.05). Mortality occurred in 7 patients with sPESI <1 and in 16 patients with sPESI ≥1. The mortality rate was higher in patients with lower RVOT-FS, and a RVOT-FS <0.22 predicted mortality with a sensitivity of 54.5% (AUC: 0.674, 95% CI 0.552-0.796; p=0.009).
CONCLUSION The RVOT-FS is a noninvasive measurement of RV systolic function, is well-correlated with the sPESI score, and associated with mortality in patients with APE. This easily applied measurement may be used to predict short-term mortality in patients with APE.
Echocardiography, fractional shortening; pulmonary embolism; Pulmonary Embolism Severity Index; right ventricular function.
How to cite this article
Ekrem Şahan, Murat Karamanlıoğlu, Suzan Şahan, Murat Gül, Ahmet Korkmaz, Omaç Tüfekçioğlu. The relationship between right ventricular outflow tract fractional shortening and Pulmonary Embolism Severity Index in acute pulmonary embolism. Turk Kardiyol Dern Ars. 2017; 45(8): 709-714
Corresponding Author: Ekrem Şahan, Türkiye