Right Ventricular Function In Patients With Pulmonary Embolism Technology Evaluation Speckle Tracking

Purpose:The aim of this study was to investigate if the speckle trackingechocardiography can detect right ventricula（rRV）dysfunction in patientswith pulmonary embolism（PE），be helpful for clinical treatment andimprove prognosis.Methods:PE patients24patients （male16, female8; age30-65years, mean age46.9±19.2years；）have been diagnosed with PE in the48hours based on computedtomography pulmonary angiography （CTPA）in the second hospital ofJilin University from January to December2012. The exclusion of severepulmonary embolism, a variety of severe valvular heart disease, leftventricular dysfunction, the presence of organic heart disease, rightventricular outflow tract obstruction and various types of arrhythmia inpatients with.Controls20health volunteers （male11, female9; age32-60years, mean age45.8±13.5years；）were recruited. No history of hypertension, anginapectoris before and other cardiovascular diseases, echocardiography andECG examination were normal, the cardiac function in NYHA I level. Procedure:Echocardiography was performed with the subjects at rest in the leftlateral decubitus position using iE33echocardiographic scanner （PhilipsHealthcare, Netherlands）.The apical four-chamber view was used to measure the right atrium (RA)and the right ventricular (RV) dimension and calculate RV ejectionfraction (RVEF) with the four-plane Simpson method from2D images,and Continuous-wave (CW) Doppler was performed to measure thevelocity of the tricuspid regurgitation jet and calculate the peak pressuregradient between the RV and the RA. With the use of the short-axisparasternal scan at aortic root, pulmonary artery (PA) diameter wasobtained.2D-strain echocardiographyThe software (Q-LAB) then automatically tracked wall motion overthe entire cardiac cycle and displayed the curves of strain (S) and strainrate (SR) of the segments of the RV. The following parameters of the RVlongitudinal S and SR were analyzed: the peak systolic strain (S), thepeak systolic strain rate (SRs) the early diastolic strain rate (SRe)， thelate diastolic strain rate (SRa).The two-dimensional image of the apical four-chamber view inputQLAB6.0workstation, start the TMQA analysis software, manuallabeling of3points of interest, were right ventricular free wall and septalinsertion point in annulus and apex, automatic tracking of the motion trajectory of computer, gets the right ventricular free wall of the tricuspidannulus systolic peak displacement, the interventricular septum of thetricuspid annular systolic peak displacement, the midpoint of the tricuspidannulus systolic peak displacement.Tissue Doppler imaging (TDI) of the RV was performed in the apicalfour-chamber view. Tricuspid annular systolic velocities (Sa) as well asearly (Ea) and late diastolic velocities (Aa) were measured in lateral RVwall. The TDI Tei-index was calculated as (a’-b’)/b’, a’ is the timeinterval between the end of myocardial velocity during late diastole (Aa)and the onset of myocardial velocity during early diastole (Ea), and b’ isthe duration of myocardial velocity during systole (Sa). Theelectrocardiogram (ECG) Tei-index is defined as the isovolumiccontraction time (ICT) and the isovolumic relaxation time (IRT) dividedby the ejection time (ET).Results:Compared with the control group. S, SRs, SRe and SRa of the apical，the middle and basal segments of RV free wall decreased significantly inthe patient group (p<0.05),and the TDI Tei-index of RV increasedsignificantly in the patient group (p<0.05), compared with the controlgroup. RVEF was significantly correlated with tricuspid annular planesystolic excursion (p<0.05). Conclusions:1. The longitudinal strain and strain rate of RV has a high accuracy ratingfor detecting each segment of RV free wall dysfunction. S and SR mighthelp to detect early RV dysfunction in patients with PE.2. The TDI Tei-index can provide additional information for assessing theglobal RV function.3. Tricuspid annular plane systolic excursion as an objective methodsignificantly correlates with RVEF has a high predictive value forevaluating RV function in patients with PE.