Diagnostic Value of Pulsed Doppler Echocardiography in Acute Pulmonary Thromboembolism

Abstract

cute pulmonary thromboembolism (APTE) is a lifethreatening condition that is often difficult to diagnose in routine clinical practice. It is usually confirmed by pulmonary angiography (PAG), 1 ventilation/ perfusion lung scintigraphy 2 or helical computed tomography (CT), 3 and the severity of APTE is often evaluated either by assessing the volume of the thrombus on PAG 1,4 or by measuring pulmonary artery pressure (PAP). It can also be evaluated non-invasively using electrocardiography (ECG) 5 or echocardiography (UCG). 6,7 On ECG, serial changes in negative T-waves are useful for evaluating the prognosis of APTE, 5 but the T wave can be influenced by a variety of factors, such as the severity and duration of the disease. UCG has been used to evaluate the right ventricular (RV) pressure overload in APTE, but although various UCG parameters, such as the pressure gradient calculated from tricuspid regurgitation (TR), 8,9 the RV end-diastolic dimension (RVDd) and RV function, have been used to evaluate the severity of APTE, the detection of a decrease in TR depends on the level of PAP. [11][12][13] Moreover, analysis of RV motion is actually required to precisely evaluate the RV dimensions or configuration. 14,15 On the other hand, in patients with chronic cor pulmonale, several studies have demonstrated a close correlation between PAP and the ratio of acceleration time to RV ejection time (AcT/RVET) measured by pulsed Doppler Japanese Circulation Journal Vol.65, March 2001 UCG. [16][17][18][19][20] In the present study, we examined the serial changes in AcT/RVET in patients with APTE, from disease onset, and compared these findings with other simultaneously determined hemodynamic indices and PAG findings. In particular, we evaluated the relationship between AcT/ RVET and PAG findings after normalization of PAP. Methods Subjects and MeasurementsBetween 1994 and 1998, 23 patients were diagnosed with APTE by angiography and 16 were prospectively enrolled in the present study. The inclusion criteria were: (i) the patient was free of pre-existing cardiopulmonary disease, and (ii) the patient responded favorably to thrombolysis within 14 days of the onset of symptoms. The remaining 7 cases were excluded from the study because they had a history of previous cardiopulmonary disease (including APTE), or had died within 1 week of thrombolysis, or had failed to respond to thrombolytic therapy (no change in PAG indices and PAP). UCG, PAG and measurement of PAP were performed in the patients before and after treatment. The mean age of the participating subjects was 66.7±8.2 years (range, 52-78), and included 1 male and 15 females. The ECG showed sinus rhythm on admission, except in 1 patient who had a right bundle branch block. Measurement of PAPCardiac catheterization was performed as follows: a 7F Swan-Ganz catheter (Edwards Critical-Care Division, Irvine, CA, USA) was inserted through the right internal jugular vein before PAG (if this proved to be difficult to perform, Jpn Circ J 2001; 65: 171 -176 (Received August 7...