Imaging of right ventricle in predicting the development of chronic thromboembolic pulmonary hypertension (CTEPH)

Abstract

There is increasing evidence in the literature emphasizing the importance of right ventricular(RV) imaging in the prognosis of pulmonary hypertension. We aimed to investigate the predictive role of RV dysfunction parameters assessed by echocardiography(ECHO) and thorax computed tomography(CT) in developing CTEPH. Patients diagnosed with pulmonary embolism(PE) prospectively included. All patients underwent ECHO and CT within 24hours after admission. We repeated CT and ECHO after 6 months and 1 year to assess the incidence of CTEPH and assess the predictive role of RV dysfunction factors in the development of CTEPH. Twenty-two patients (7 of whom were male) with a mean age of 53.9±17.9years were included; CTEPH developed in two patients during the follow-up. Baseline PO2 levels were significantly lower in patients with CTEPH(61.5±11.4vs77.8±25.2,p<0.05). The baseline RV diameter, RV EF, and systolic PAP levels evaluated by ECHO differed significantly in two patients who developed CTEPH. The lowest RVS were detected in two patients that developed CTEPH (-10.3%and-11.7%). This study claimed that the presence of hypoxemia, decreased RV EF, RVS, increased systolic PAP values in ECHO, and increased RV/LV ratio evaluated in thorax CT indicate the severity of RV dysfunction in acute PE and may predict CTEPH development.

Keywords

• Hypertension
• echocardiography
• pulmonary circulation
• right ventricle

References

1. 1. Pengo V et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism.N Engl J Med 2004;350(22):2257-64.
2. 2. Ribeiro A et al. Pulmonary embolism: one-year follow-up with echocardiography doppler and five-year survival analysis. Circulation 1999;99(10):1325-30.
3. 3. Galiè N et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS).Eur Heart J 2016;37(1): 67-119.
4. 4. Auger WR et al. Chronic thromboembolic pulmonary hypertension.Clin Chest Med 2007;28(1):255-69.
5. 5. Bonderman D et al. Risk factors for chronic thromboembolic pulmonary hypertension.Eur Respir J 2009;33(2):325-31.
6. 6. Azpiri-Lopez JR et al. Echocardiographic evaluation of pulmonary hypertension, right ventricular function, and right ventricular-pulmonary arterial coupling in patients with rheumatoid arthritis.Clin Rheumatol 2021;40(7):2651-56.
7. 7. Guo X et al.Predictive value of non-invasive right ventricle to pulmonary circulation coupling in systemic lupus erythematosus patients with pulmonary arterial hypertension.Eur Heart J Cardiovasc Imaging 2021;22(1):111-8.
8. 8. Singh S and Lewis MI. Evaluating the Right Ventricle in Acute and Chronic Pulmonary Embolism: Current and Future Considerations.Semin Respir Crit Care Med 2021;42(2):199-211.

9. 9. Dentali F et al. Incidence of chronic pulmonary hypertension in patients with previous pulmonary embolism.Thromb Res 2009;124(3):256-8.
10. 10. Kayaalp I et al. The incidence of chronic thromboembolic pulmonary hypertension secondary to acute pulmonary thromboembolism.Tuberk Toraks.2014;62(3):199-206.
11. 11. McGoon M et al. Screening, early detection, and diagnosis of pulmonary arterial hypertension:ACCP evidence-based clinical practice guidelines.Chest 2004;126(1 Suppl):14S-34S.
12. 12. Berghaus TM et al. Echocardiographic evaluation for pulmonary hypertension after recurrent pulmonary embolism.Thromb Res 2011;128(6):e144-7.
13. 13. Shiino K et al. (2014). Usefulness of right ventricular basal free wall strain by two-dimensional speckle tracking echocardiography in patients with chronic thromboembolic pulmonary hypertension.Int Heart J 2015;56(1):100-4.
14. 14. Sugiura E et al. Reversible right ventricular regional non-uniformity quantified by speckle-tracking strain imaging in patients with acute pulmonary thromboembolism.J Am Soc Echocardiog 2009;22(12):1353-9.
15. 15. Platz E et al. Regional right ventricular strain pattern in patients with acute pulmonary embolism. Echocardiography 2012;29(4):464-70.
16. 16. Collomb D et al. Severity assessment of acute pulmonary embolism:evaluation using helical CT.Eur Radiol 2003;13(7):1508-14.
17. 17. Reid JH and Murchison JT. Acute right ventricular dilatation:a new helical CT sign of massive pulmonary embolism.Clin Radiol 1998;53(9):694-8.
18. 18. Quiroz R et al. Right ventricular enlargement on chest computed tomography: prognostic role in acute pulmonary embolism.Circulation 2004 25;109(20):2401-4.
19. 19. Nural MS et al. Computed tomographic pulmonary angiography in the assessment of severity of acute pulmonary embolism and right ventricular dysfunction.Acta Radiol 2009;50(6):629-37.
20. 20. Ende-Verhaar YM et al. Sensitivity of a Simple Non-invasive Screening Algorithm for Chronic Thromboembolic Pulmonary Hypertension after Acute Pulmonary Embolism. TH Open. 2018 27;2(1):e89-e95.
21. 21. Korkmaz A et al. Long-term outcomes in acute pulmonary thromboembolism: the incidence of chronic thromboembolic pulmonary hypertension and associated risk factors.Clin Appl Thromb Hemost 2012;18(3):281-8.