Abstract
Background
Right ventricular (RV) involvement in pulmonary embolism (PE) is an ominous sign.
The aim of this study was to investigate the extent to which the d-dimer level or simplified PE severity index (sPESI) indicates RV dysfunction in patients
with preserved systemic arterial pressure.
Methods
Right ventricular function was studied in 34 consecutive patients with acute nonmassive
PE by echocardiography including Doppler tissue imaging within 24 hours after arrival
to the hospital. d-Dimer and sPESI were assessed upon arrival.
Results
d-Dimer correlated with RV pressure (Rs, 0.60; P < .001) and pulmonary vascular resistance (PVR; Rs, 0.68; P < .0001) and tended to be related to myocardial performance index (MPI; Rs, 0.31; P = .067). Compared to a level less than 3.0 mg/L, patients with d-dimer 3.0 mg/L or higher had lower systolic tricuspid annular velocity (11.3 ± 2.7
vs 13.5 ± 2.7 cm/s; P < .05), a prolonged MPI (0.8 ± 0.3 vs 0.5 ± 0.2; P < .01), increased RV pressure (58 ± 13 vs 37 ± 12 mm Hg; P < .001), and increased PVR (3.3 ± 1.1 vs 1.8 ± 0.4 Woods units; P < .001). Patients in the high-risk sPESI group had higher filling pressure than those
in the low risk sPESI group.
Conclusions
In the acute stage of PE, a d-dimer level 3 mg/L or higher may identify nonmassive PE patients with RV dysfunction
and thereby help to determine their risk profile. We found no additional value for
sPESI in this context.
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Article Info
Publication History
Published online: November 14, 2012
Accepted:
September 11,
2012
Received in revised form:
September 11,
2012
Received:
July 6,
2012
Footnotes
☆This study was supported partly by the Swedish Heart Lung Foundation, the Swedish Research Council, and the Stockholm County Council, Stockholm, Sweden.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
