Assessment Of Right Ventricular Long-axis Function In Patients With Acute Pulmonary Thromboembolism Using Tissue Doppler Imaging

Objection: To assess the change of the right ventricular long-axis function in patients with acute pulmonary thromboembolism (APE) before and after anticoagulant and/or thrombolytic therapy and to discuss its clinical value. Methods: 36 patients with APE and 30 healthy volunteers matched with age and sex were studied. The right ventricular end-diastolic diameter (RA), ratio of right to left ventricular end-diastolic diameter (RV/LV) and ratio of right to left atrial end-diastolic diameter (RA/LA) were measured and calculated in the apical four chamber view was measured in the parasternal short axis view and inferior vena cava (IVC) was measured in view by transthoracic two-dimensional echocardiography. From the apical four chamber view, the image of tricuspid, mitral inflow and tricuspid regurgitation was obtained and early diastolic peak flow velocity (E), late diastolic peak flow velocity (A) and E/A ratio were measured. Using tissue Doppler imaging (TDI), the lateral tricuspid annular systolic peak velocity (SM), the systolic excursion (DS), the pre-contraction time (PCTm), contraction time (CTM), PCTm/CTm ratio, early diastolic myocardial motion velocity (EM), late diastolic peak myocardial motion velocity (AM) and the ratio of Em/Am (Em/Am) were measured. Results: RV, RV/LV, RA/LA, IVC, E and E/A ratio of tricuspid inflow imaging were significantly different between patients with APE and normal controls. Comparing to normal controls, Sμ and Ds in patients were significantly decreased (10.8±2.1cm/s, 1.72±0.33 cm vs 14.5+2.0 cm/s, 2.20±0.21 cm, P<0.001) and PCTm/CTm ratio was significantly increased (0.38±0.06 vs 0.34±0.06, P<0.01). There were no differences in PCTM and CTM between the APE and control group. EM and Em/Am ratio were significantly lower (10.3±2.2cm/s, 0.89±0.20 vs 14.7±2.5cm/s, 1.22±0.17cm, P<0.001) than in the control group. There was no difference in AM(P<0.001) in two groups. Followed by the increase of pulmonary artery systolic pressure, SM and EM decreased gradually, PCTm/CTm and Em/Am increased gradually. Linear correlation analysis showed there was excellent correlation between pulmonary artery systolic pressure and the lateral tricuspid annular Sμ, Ds and Em/Am. There was excellent linear correlation between the CT index and SM and Em/Am. Compared to the control group, E and E/A ratio of mitral inflow imaging were significantly decreased and EDECT were significantly elongation in APE group compared with healthy controls. There was no difference in A between two groups. After anticoagulant and/or thrombolytic therapy, RV, RV/LV ratio, RA/LA ratio and E were significantly increased, but IVC, PASP and E/A were significantly decreased. SM, DS, EM and EM/AM ratio were significantly increased(13.3±1.5cm/s, 2.02±0.22cm, 12.9±1.9cm/s, 1.12±0.20 vs 10.8±...