Overload of the Right Ventricle in Patients with Pulmonary Embolism: Analysis of New Evaluation Criteria

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Abstract

INTRODUCTION: The increasing incidence of pulmonary embolism (PE) and high mortality from it necessitates development of new echocardiographic (EchoCG) criteria for assessing the severity of pressure and volume overload of the right ventricle (RV) in patients with PE.

AIM: To perform critical analysis of the developed EchoCG criteria of overload of the right heart chambers in PE with the aim to determine severity of the course and outcomes of the disease.

MATERIALS AND METHODS: The study included 428 patients with PE divided to 4 groups: group 1 — 42 patients with recorded death, group 2 — 51 patients with hemodynamically significant disease, group 3 — 193 hemodynamically stable patients with EchoCG signs of the overload of the right ventricle, group 4 — 142 patients with no identified symptoms. Comparison of the developed EchoCG criteria was conducted: the volume of tricuspid regurgitation, its ratio to the volume of the right atrium and the stroke volume of the heart, and also the pressure in the pulmonary trunk, the pressure gradient on the pulmonic valve and its ratio to the pressure gradient on the tricuspid valve in the studied groups with the determination of threshold values having diagnostic and prognostic significance.

RESULTS: It was found that the level of the estimated pressure gradient on the pulmonic valve has statistically significant correlation with the hemodynamic significance of the course of the disease (r = 0.91, р < 0.01) and fatal outcome (r = 0.99, р < 0.01) and possesses high sensitivity (more than 92.7%) and specificity (more than 97.8%). This parameter is proved to be the most important prognostic EchCG criterion. To determine the expression of the RV dysfunction and the priority flow of blood from its cavity, the following parameters equivalent to EhcoCG, such as the ratio of pressure gradient on the pulmonic artery to the pressure gradient on the tricuspid valve and the ratio of the tricuspid regurgitation volume to the stroke volume, are also significant.

CONCLUSION: Calculation of the pressure gradient on the pulmonic valve and its correlation with the pressure gradient on the tricuspid valve, just as the ratio of the volume of tricuspid regurgitation to the stroke volume can be reliable criteria for assessment of the hemodynamic significance of PE and predictors of its outcome.

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About the authors

Andrey G. Pronin

Pirogov National Medical and Surgical Center

Author for correspondence.
Email: lek32@yandex.ru
ORCID iD: 0000-0002-8530-2467
SPIN-code: 6285-5800

MD, Dr. Sci. (Med.), Associate Professor

Russian Federation, Moscow

Nataliya Yu. Sivokhina

Pirogov National Medical and Surgical Center

Email: sivokhinan24@mail.ru
ORCID iD: 0000-0003-4553-6389
SPIN-code: 8920-2670

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Mikhail A. Goncharov

Pirogov National Medical and Surgical Center

Email: drmihailgoncharov@gmail.com
ORCID iD: 0000-0001-6991-1599
SPIN-code: 6178-1890
Russian Federation

References

  1. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543–603. doi: 10.1093/eurheartj/ehz405
  2. Bagrova IV, Kukharchik GA, Serebriakova VI, et al. The modern approaches to diagnostics of pulmonary embolism. Flebologiya. 2012;6(4):35–42. (In Russ).
  3. Berns SA, Schmidt EA, Neeshpapa AG, et al. Risk factors associated with the development of death events during the first year of follow-up after pulmonary thromboembolism. Medical Council. 2019;(5):80–5. (In Russ). doi: 10.21518/2079-701X-2019-5-80-85
  4. Kovaleva GV, Koroleva LYu, Amineva NV, et al. The difficulties in differential diagnosis of pulmonary thromboembolism in a therapeutic clinic. The rupture of the diverticulum of esophagus, imitating thromboembolism of the pulmonary artery (case from practice). Meditsinskiy Al’manakh. 2018;(1):98–100. (In Russ).
  5. Becattini C, Agnelli G. Acute treatment of venous thromboembolism. Blood. 2020;135(5):305–16. doi: 10.1182/blood.2019001881
  6. Panchenko EP, Balahonova TV, Danilov NM, et al. Diagnosis and management of pulmonary embolism: Eurasian Association of Cardiology (EAC) Clinical Practice Guidelines (2021). Eurasian Heart Journal. 2021;(1):44–77. (In Russ). doi: 10.38109/2225-1685-2021-1-44-77
  7. Barco S, Mahmudpur SH, Plunketka B, et al. Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: a systematic review and meta-analysis. Eur Heart J. 2019;40(11):902–10. doi: 10.1093/eurheartj/ehy873
  8. Burgos LM, Scatularo CE, Cigalini IM, et al. The addition of echocardiographic parameters to PESI risk score improves mortality prediction in patients with acute pulmonary embolism: PESI-Echo score. Eur Heart J Acute Cardiovasc Care. 2021;10(3):250–7. doi: 10.1093/ehjacc/zuaa007
  9. Lahham S, Fox JC, Thompson M, et al. Tricuspid annular plane of systolic excursion to prognosticate acute pulmonary symptomatic embolism (TAPSEPAPSE study). J Ultrasound Med. 2019;38(3):695–702. doi: 10.1002/jum.14753
  10. Russian Clinical Guidelines for the Diagnostics and Treatment of Chronic Venous Diseases. Flebologiya. 2018;12(3):146–240. (In Russ). doi: 10.17116/flebo20187031146
  11. Netylko JE, Teterina MA, Pisaryuk AS, et al. Prognostic value of echocardiographic parameters in patients with pulmonary embolism. Klinicheskaya Farmakologiya i Terapiya. 2021;30(3):52–6. (In Russ). doi: 10.32756/0869-5490-2021-3-52-56
  12. Neklyudova GV, Naumenko ZhK. Ultrasound diagnostic opportunities in pulmonology. Russian Pulmonology. 2017;27(2):283–90. (In Russ). doi: 10.18093/0869-0189-2017-27-2-283-290
  13. Dzhioeva ON, Orlov DO, Nikitin IG. Echocardiography in acute cardiovascular care. Part 2. Cardiac and lung ultrasound examination. Complex Issues of Cardiovascular Diseases. 2020;9(3):49–58. (In Russ). doi: 10.17802/2306-1278-2020-9-3-49-58
  14. Lyhne MD, Kabrhel C, Giordano N, et al. The echocardiographic ratio tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure predicts short-term adverse outcomes in acute pulmonary embolism. Eur Heart J Cardiovasc Imaging. 2021;22(3):285–94. doi: 10.1093/ehjci/jeaa243
  15. Kochmareva ЕА, Kokorin VА, Volkova АL, et al. Modern possibilities of prediction of clinical course and outcome of pulmonary embolism. Medical News of North Caucasus. 2017;12(4):476–83. (In Russ). doi: 10.14300/mnnc.2017.12133
  16. Bautin AE, Osovskikh VV. Acute right ventricular failure. Messenger of Anesthesiology and Resuscitation. 2018;15(5):74–86. (In Russ). doi: 10.21292/2078-5658-2018-15-5-74-86
  17. Erlikh AD, Barbarash OL, Berns SA, et al. SIRENA score for in-hospital mortality risk assessment in patients with acute pulmonary embolism. Russian Journal of Cardiology. 2020;25(4S):4231. (In Russ). doi: 10.15829/1560-4071-2020-4231
  18. Arshad N, Bjøri E, Hindberg K, et al. Recurrence and mortality after first venous thromboembolism in a large population-based cohort. J Thromb Haemost. 2017;15(2):295–303. doi: 10.1111/jth.13587
  19. Sheypak AA. Gidravlika i gidropnevmoprivod. Osnovy mekhaniki zhidkosti i gaza. 6th ed. Moscow: INFRA-M; 2017. (In Russ).
  20. Evlakhov VI, Pugovkin AP, Rudakova TL, et al. Vvedeniye v fiziologiyu serdtsa. Saint-Petersburg: SpetsLit; 2019. (In Russ).

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