Prognostic significance of right ventricular hypokinesis and perfusion lung scan defects in pulmonary embolism

doi:10.1016/0002-8703(94)90058-2

American Heart Journal

Volume 127, Issue 5, May 1994, Pages 1371-1375

https://doi.org/10.1016/0002-8703(94)90058-2 Get rights and content

Abstract

We studied the relation between right ventricular (RV) hypokinesis on echocardiography and defects on the initial perfusion lung scan among 90 hemodynamically stable patients with pulmonary embolism (PE). Of the 90, 38 had qualitative evidence of RV hypokinesis, with a mean RV end-diastolic area significantly larger than those with normal RV wall motion (40.0 ± 10.2 cm² vs 20.1 ± 6.4 cm²; p < 0.001). The degree of the perfusion defect was greater in those patients with baseline RV hypokinesis (54% ± 16% of the lung nonperfused) than in those patients with normal RV wall motion at baseline (30% ± 18% nonperfused lung; p < 0.001). Receiver operating characteristic curve analysis showed that a perfusion lung scan defect score of 0.3 (i.e., 30% of the lung nonperfused) had a 92% sensitivity for predicting RV hypokinesis and carried a relative risk for observing RV hypokinesis of 6.8 times greater than among those patients with a perfusion scan score of <0.3. Considering that all patients with recurrent symptomatic PE were in the subgroup with RV hypokinesis (13% vs 0% for those with normal RV wall motion; p = 0.01), a strategy of performing echocardiography in those patients with a perfusion scan defect score of ≥0.3 appears to identify patients at increased risk for recurrent PE.

References (6)

SZ Goldhaber et al.
Alteplase versus heparin in acute pulmonary embolism: randomized trial assessing right ventricular function and pulmonary perfusion
Lancet
(1993)
F Jardin et al.
Quantitative two-dimensional echocardiography in massive pulmonary embolism: emphasis on ventricular interdependence and leftward septal displacement
J Am Coll Cardiol
(1987)
PC Come et al.
Early reversal of right ventricular dysfunction in patients with acute pulmonary embolism after treatment with intravenous tissue plasminogen activator
J Am Coll Cardiol
(1987)

There are more references available in the full text version of this article.

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Prognostic significance of right ventricular hypokinesis and perfusion lung scan defects in pulmonary embolism

Abstract

Lancet

J Am Coll Cardiol

J Am Coll Cardiol