Atrial arrhythmias and scintigraphic “D-shape” sign in pulmonary artery hypertension

Ferrando-Castagnetto, Federico; Ricca-Mallada, Roberto; Selios, Valentina; Ferrando, R

doi:10.4103/1450-1147.181152

Cited by 3 publications

(3 citation statements)

References 10 publications

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“…Consistent with previous studies of patients with acute PE in whom RV dysfunction was documented, there is a subjective component to this interpretation, particularly when echocardiography is the imaging modality utilized. In addition, while a measured RV/LV ratio > 0.9 in the apical 4 chamber view on either CTA or echocardiography suggests RV dilation, volume status, and chronic medical conditions such as obesity, pulmonary hypertension, and right-sided valvular insufficiency all augment RV loading conditions may be interpreted as evidence of "RV dysfunction" [20,[32][33][34]. These factors require external validation.…”

Section: Discussionmentioning

confidence: 99%

Right ventricular dysfunction is superior and sufficient for risk stratification by a pulmonary embolism response team

Chen

Wright

Pietropaoli

et al. 2019

J Thromb Thrombolysis

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Introduction: Several risk stratification tools are available to predict short-term mortality in patients with acute pulmonary embolism (PE). The presence of ventricular (RV) dysfunction is an independent predictor of mortality and may be a more efficient way to stratify risk for patients assessed by a Pulmonary Embolism Response Team (PERT). Methods:We evaluated 571 patients presenting with acute PE, then stratified them by the Pulmonary Embolism Severity Index (PESI), by the BOVA score, or categorically as low risk (no RV dysfunction by imaging), intermediate risk (RV dysfunction by imaging), or high risk PE (RV dysfunction with sustained hypotension). Using imaging data to firstly define the presence of RV strain, and plasma cardiac biomarkers as additional evidence for myocardial dysfunction, we evaluated whether PESI, BOVA, or RV strain were more appropriate for determining patient risk by a PERT where rapid decision making is important.Results: Cardiac biomarkers poorly distinguished between PESI classes and BOVA stages in patients with acute PE. Cardiac TnT and NT-proBNP easily distinguished low risk from submassive PE with an area under the curve (AUC) of 0.84 (95% C.I. 0.73 -0.95, p< 0.0001), and 0.88 (95% C.I. 0.79-0.97, p< 0.0001), respectively. Cardiac TnT and NT-proBNP easily distinguished low risk from massive PE with an area under the curve (AUC) of 0.89 (95% C.I. 0.78 -1.00, p< 0.0001), and 0.89 (95% C.I. 0.82-0.95, p< 0.0001), respectively. In patients with RV dysfunction, the predicted short-term mortality by PESI score or BOVA stage was lower than the observed mortality by a two-fold order of magnitude.

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Section: Discussionmentioning

confidence: 99%

Right ventricular dysfunction is superior and sufficient for risk stratification by a pulmonary embolism response team

Chen

Wright

Pietropaoli

et al. 2019

J Thromb Thrombolysis

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“…In addition, while a measured RV/LV ratio > 0.9 in the apical 4 chamber view on either CTA or echocardiography suggests RV dilation, volume status, and chronic medical conditions such as obesity, pulmonary hypertension, and right-sided valvular insufficiency all augment RV loading conditions. Therefore, any cause of increased contrast noted in the pulmonary vasculature and RV by CTA is subject to being interpreted as evidence on "RV dysfunction", as reported 20,[32][33][34] . Our study also excluded patients with a pre-existing diagnosis of VTE/PE, or patients with diagnosis of acute PE at an outside facility who were later transferred in to our institution.…”

Section: Discussionmentioning

confidence: 99%

Categorical Assignment of Pulmonary Embolism is a Simple and More Accurate Indicator of Right Ventricular Dysfunction and Short Team Mortality

Chen¹,

Wright

Pietropaoli

et al. 2019

Preprint

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word count: 285. Manuscript word count: 2325Abstract Several risk stratification tools are available to predict short-term mortality in patients with acute pulmonary embolism (PE). Right ventricular (RV) dysfunction, which is common to intermediate and high risk PE, is an independent predictor of mortality and may be a faster and simpler way to assess patient risk in acute care settings.We evaluated 571 patients presenting with acute PE as the primary diagnosis, stratifying them by the Pulmonary Embolism Severity Index (PESI), by the BOVA score, or categorically as low risk (no RV dysfunction by imaging), intermediate risk (RV dysfunction by imaging), or high risk PE (RV dysfunction by imaging with sustained hypotension). Using imaging data to firstly define the presence of RV dysfunction, and plasma cardiac troponin T (cTnT) and NT-proBNP as additional evidence for myocardial strain, we evaluated the PESI and BOVA scoring systems compared to categorical assignment of PE as low risk, submassive, and massive PE. Cardiac biomarkers poorly distinguished between PESI classes and BOVA stages in patients with acute PE. Cardiac TnT and NT-proBNP easily distinguished low risk from submassive PE with an area under the curve (AUC) of 0.84 (95% C.I. 0.73 -0.95, p< 0.0001), and 0.88 (95% C.I. 0.79-0.97, p< 0.0001), respectively, and low risk from massive PE with an area under the curve (AUC) of 0.89 (95% C.I. 0.78 -1.00, p< 0.0001), and 0.89 (95% C.I. 0.82-0.95, p<0.0001), respectively. Predicted short-term mortality by PESI score or BOVA stage was lower than the observed mortality for submassive PE by a two-fold order of magnitude.These data suggest the presence of RV dysfunction in the context of acute PE is sufficient for the purposes of risk stratification, while more complicated risk stratification algorithms may under-estimate short-term mortality risk.

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“…Transthoracic echocardiography (TTE) in a patient with advanced PAH is conspicuous by the RV cavity′s abnormal shape, especially in the parasternal short axis ( Figure 5 ). The RV assumes a spherical shape, and the interventricular septum protrudes into the LV, forming the so-called D-shape sign [ 18 ]. If a D-shaped LV appears in the end-diastolic phase, it suggests RV pressure overload, whereas a D-sign shape in diastole suggests RV volume overload [ 19 , 20 ].…”

Section: The Assessment Of the Right Heart Cavities And Pericardial Dimensions Using Transthoracic Echocardiographymentioning

confidence: 99%

Echocardiography in Pulmonary Arterial Hypertension: Comprehensive Evaluation and Technical Considerations

Topyła-Putowska

Tomaszewski

Wysokiński

et al. 2021

JCM

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Pulmonary arterial hypertension (PAH) is a rare, progressive disease in which there is a persistent, abnormal increase in pulmonary artery pressure. Symptoms of pulmonary hypertension are nonspecific and mainly associated with progressive right ventricular failure. The diagnosis of PAH is a multistep process and often requires the skillful use of several tests. The gold standard for the diagnosis of PAH is hemodynamic testing. Echocardiography currently plays an important role in the diagnostic algorithm of PAH as it is minimally invasive and readily available. Moreover, many echocardiographic parameters are closely related to pulmonary hemodynamics. It allows assessment of the right heart′s structure and function, estimation of the pressure in the right ventricle, right atrium, and pulmonary trunk, and exclusion of other causes of elevated pulmonary bed pressure. Echocardiographic techniques are constantly evolving, and recently, measurements made using new techniques, especially 3D visualization, have become increasingly important. In echocardiographic assessment, it is crucial to know current guidelines and new reports that organize the methodology and allow standardization of the examination. This review aims to discuss the different echocardiographic techniques used to evaluate patients with PAH.

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Atrial arrhythmias and scintigraphic “D-shape” sign in pulmonary artery hypertension

Cited by 3 publications

References 10 publications

Right ventricular dysfunction is superior and sufficient for risk stratification by a pulmonary embolism response team

Right ventricular dysfunction is superior and sufficient for risk stratification by a pulmonary embolism response team

Categorical Assignment of Pulmonary Embolism is a Simple and More Accurate Indicator of Right Ventricular Dysfunction and Short Team Mortality

Echocardiography in Pulmonary Arterial Hypertension: Comprehensive Evaluation and Technical Considerations

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