ASSESSMENT OF RIGHT VENTRICULAR SIZE, DYSFUNCTION AND BIOMARKERS IN PATIENTS WITH NON HIGH-RISK PULMONARY EMBOLISM

Abstract

Objective. To investigate the significance of right ventricular (RV) echocardiographic changes in size, function and laboratory biomarkers in patients with non-high-risk pulmonary embolism (PE). Methods. A retrospective study of patients with non-high-risk acute PE who were treated at the Pulmonology Department of The Hospital of Lithuanian University of Health Sciences Kauno klinikos from 2019 January 1 until 2019 December 31 was performed. Echocardiographic signs of RV dysfunction and congestion, as well as laboratory markers (troponin I (TnI) and N-terminal natriuretic peptide (NT-pro-BNP), were evaluated. Death rates in PE patients were assessed at 30, 90 days, and 12 months. Results. The study included 157 patients with acute PE (69 (56.1%) men and 88 (43.9%) women) with a mean age of 68.7 years. The number of deaths in women at 30 days was statistically significantly lower than in men (p <0.05), but after 90 days and 12 months, there was no significant difference between the sexes. Echocardiographic signs of RV dysfunction were found in 89 patients, TnI elevation in 50 patients and NT-proBNP elevation in 20 patients, 69.0%, 62.5%, and 90.9%, respectively of those patients in whom these tests were performed. The number of deaths within 30 days from the determination of PE was 15 (9.6%), 90 days – 23 (14.6%), 12 months – 32 (20.4%). There was a statistically significant increased risk of death at 30, 90 days, and 12 months with decreased peak systolic velocity of the tricuspid annulus, dilatation of the RV, and decreased tricuspid annular plane systolic excursion (TAPSE). Increased risk of death at 90 days and 12 months with increased tricuspid regurgitation velocity (p<0.05). An association between increases in laboratory markers and higher death rates could not be demonstrated (p>0.05). This may be due to the small number of tests performed. Conclusions. In assessing the risk of PE death, echocardiographic changes in RV size and function help predict the risk of early and late death.