Echocardiographic features in the screening for pulmonary hypertension in pulmonary embolism survivors

Abstract

Introduction: Acute pulmonary thromboembolism (PE) represents a major cause of cardiovascular morbidity and mortality. Assessment of right ventricular (RV) function after an PE episode is crucial for evaluating the risk of chronic thromboembolic pulmonary hypertension (CTEPH) and ventricular dysfunction. Three-dimensional echocardiography (3D TTE) and speckle tracking parameters are modern methods capable of assessing both systolic function and myocardial deformation of the RV, potentially providing additional diagnostic and prognostic value compared to two-dimensional echocardiography. Aim of the study: To identify the relationships between various echocardiographic parameters of RV dysfunction and clinical and biochemical markers in predicting pulmonary hypertension and right ventricular dysfunction in patients who have experienced PE. Material and method: The study included 42 patients with a history of PE, who underwent echocardiographic evaluation at 3-6 months post-acute event. Various right ventricular function parameters were assessed, including 3D RVEF and RV Strain. Additionally, biochemical markers NTproBNP and D-dimers were measured, and patients were stratified according to NYHA, MRC, PVT functional classifications, and grouped based on the echocardiographic probability of pulmonary hypertension (PH). Results: 3D RVEF showed significant differences among NYHA classes, with a p-value of 0.033 (ANOVA); however, no significant differences were observed between the echocardiographic probability of PH and RV deformation, measured by RV Strain (p = 0.3365) or 3D RVEF (p = 0.5992). Significant correlations were identified between RV Strain and TAPSE/sPAP Ratio - r = 0.51 (Pearson), 0.44 (Spearman); 3D RVEF and RV Strain - r = 0.35 (p = 0.014); and 3D RVEF and TAPSE/sPAP Ratio - r = 0.24. NTproBNP and D-dimers were negatively correlated with RV Strain (Pearson= -0.51 and -0.36, respectively). 3D RVEF proved to be a valuable marker for functional risk stratification according to NYHA classes, while RV Strain significantly correlated with pulmonary pressure parameters and RV contractility. Although biochemical markers NTproBNP and D-dimers showed negative correlations with RV deformation, they did not demonstrate a strong predictive value for PH in this study.Conclusions: The analyzed echocardiographic parameters (TAPSE/sPAP, RV A4C, RA Area, RV RVOT) and 3D RVEF and RV Strain demonstrate potential in evaluating right ventricular dysfunction and clinical risk stratification post- PE, although validation in larger cohorts is necessary to confirm these findings.