ASSESSMENT OF RIGHT VENTRICULAR FUNCTION BY ECHOCARDIOGRAPHY IN PATIENTS WITH SUB MASSIVE PULMONARY EMBOLISM IN A TERTIARY CARE CARDIAC HOSPITAL: A CASE SERIES STUDY

Abstract

Objective: To assess right ventricular function by echocardiography in 57 cases of hospitalized patients with Pulmonary Embolism.

Study Design: Descriptive cross-sectional study.

Place and Duration of Study: Adult Cardiology Department of AFIC & NIHD from 1st October 2017 till 31st December, 2019.

Material and Methods: 57 patients with pulmonary embolism were included in the study using consecutive sampling technique. Clinical characteristics and outcomes of the patients were noted and analyzed. SPSS-23 was used for data analysis.

Results: Fifty Seven (57) cases of acute pulmonary embolism (based on CT pulmonary angiography) were included in our study and were admitted to the coronary care unit of hospital during the study period. Mean age of patients was 43.64 ± 17.8 years with minimum age 20 years and maximum 83 years. There were 47 (82.5%) male while 10 (17.5%) female patients. Most common New York Heart Association (NYHA) class with which patients presented was, class IIIin 27 (47.5%) followed by class IV in 15 patients (26.3%). The most common CT Pulmonary Angiogram finding of the patients was bilateral segmental embolism seen in 34 patients (59.64%). Out of 57 patients, 22 (38.6%) patients received streptokinase and ten (17.5%) received tissue plasminogen activator. Four patients were found to have deep venous thrombosis. Mortality was 12.3% (n=7). On 2D echocardiography, mean Pulmonary Artery Pressure (PAP) was 27.88 ± 19, mean RV size 41.56 ± 7 and mean RV/LV size ratio was 0.97 ± 0.15. Mean Tricuspid annular plane systolic excursion (TAPSE) as measure of right ventricular systolic function was 17.37 ±. Mortality was higher in patients with TAPSE less than 18.

Conclusion: Acute pulmonary embolism is a relatively common medical emergency and accurate diagnosis in early period can help institute appropriate thrombolytic therapy to maximally benefit the patients. Right ventricular function can be assessed by echocardiography at bed side and its dysfunction correlates with prognosis and mortality in pulmonary embolism.