Authors
Pronin A.G., Sivokhina N.Yu., Goncharov M.A.
Pirogov National Medical and Surgical Center, Moscow
Abstract
The need to develop new non-invasive criteria for overload of the right heart in patients with pulmonary embolism.
Aims: to develop new methods for assessing blood regurgitation on the tricuspid valve during systole of the right ventricle, and to evaluate their capabilities as criteria for the severity and prognosis of the disease.
Materials and methods: the study included 428 patients with pulmonary embolism: 42 patients with fatal outcome, 244 patients with presence and 142 with absence of signs of overload of the right heart. The degree of tricuspid regurgitation was determined in all patients and its prevalence in the compared groups was analyzed, as well as its relationship with the expansion of the inferior vena cava more than 2 cm and the absence of its collapse on inspiration by 50%. The volume of tricuspid regurgitation and its ratio to the volume of the right atrium and the volume of blood ejection per systole, as well as the calculation of the heart’s work on the tricuspid valve, with the establishment of threshold values and their significance, are determined in each patient.
Results: It was found that the use of the degree of tricuspid regurgitation is significantly less informative and visual than its volume, the calculation of which, by the proposed method, is completely comparable with pathophysiological data. Significant threshold values, the excess of which was associated with the manifestation of hemodynamically significant pulmonary embolism for the ratio of tricuspid regurgitation volume to the volume of the right atrium and to the heart stroke volume, as well as for the work of the right ventricle on the tricuspid valve were 0.6, 1 and 0.5, respectively, the same values indicated the possible development of an unfavorable outcome of the disease.
Conclusions: the developed assessment methods more informatively and clearly reflect the severity of overload of the right parts of the heart and its compensation.
Keywords: pulmonary embolism, overload of the right heart, echocardiography, degree and volume of tricuspid regurgitation.
References
1. Komlev AE, Saidova MA, Imaev TE, Akchurin RS. Diagnosis and transcatheter treatment of tricuspid regurgitation. Russian Cardiology Bulletin. 2022; 17(2): 5-15. (In Russ.) doi: 10.17116/Cardiobulletin2022170215.
2. Hahn RT, Weckbach LT, Noack T, et al. Proposal for a standard echocardiographic tricuspid valve nomenclature. JACC: Cardiovascular Imaging. 2021; 14: 1299-1305. doi:10.1016/j.jcmg.2021.01.012.
3. Chorin E, Rozenbaum Z, Topilsky Y, et al. Tricuspid regurgitation and long-term outcomes. European Heart Journal: Cardiovascular Imaging. 2020; 21: 157-165. doi: 10.1093/ehjci/jez216.
4. Anvardeen K, Rao R, Hazra S, et al. Prevalence and significance of tricuspid regurgitation postendocardial lead placement. JACC: Cardiovascular Imaging. 2019; 12: 562-564. doi: 10.1016/j.jcmg.2018.07.009.
5. Praz F, Muraru D, Kreidel F, et al. Transcatheter treatment for tricuspid valve disease. Eurointervention. 2021; 17: 791-808. doi: 10.4244/EIJ-D-21-00695.
6. Kochmareva ЕА, Kokorin VА, Volkova АL, et al. Predictors of short term outcomes in high and moderate risk pulmonary thromboembolism. Russian Journal of Cardiology. 2017; 9: 7-12. (In Russ.) doi: 10.15829/1560-4071-2017-9-7-12.
7. Bautin AE, Osovskikh VV. Acute right ventricular failure. Messenger of Anesthesiology and Resuscitation. 2018; 15 (5): 74-86. (In Russ.) doi: 10.21292/2078-5658-2018-15-5-74-86.
8. Panchenko EP, Balahonova TV, Danilov NM, et al. Diagnosis and Management of pulmonary embolism: Eurasian Association of Cardiology (EAC) Clinical Practice Guidelines (2021). Eurasian heart journal. 2021; 1: 44-77 (In Russ.) doi:10.38109/2225-1685-2021-1-44-77.
9. Burgos LM, Scatularo CE, Cigalini IM, et al. The addition of echocardiographic parameters to PESI risk score improves mortality prediction in patients with acute pulmonary embolism: PESI-Echo score. Eur Heart J Acute Cardiovasc Care. 2021; 10(3): 250-257. doi: 10.1093/ehjacc/zuaa007.
10. Lahham S, Fox JC, Thompson M, et al. Tricuspid annular plane of systolic excursion to prognosticate acute pulmonary symptomatic embolism (TAPSEPAPSE study). J Ultrasound Med. 2019; 38(3): 695-702. doi:10.5811/westjem.2019.11.44968.
11. Kebed KY, Addetia K, Henry M, et al. Refining severe tricuspid regurgitation definition by echocardiography with a new outcomes-based «massive» grade.// Journal of the American Society of Echocardiography. 2020; 33: 1087-1094. doi:10.1016/j.echo.2020.05.007.
12. Peri Y, Sadeh B, Sherez C, et al. Quantitative assessment of effective regurgitant orifice: impact on risk stratification, and cut-off for severe and torrential tricuspid regurgitation grade. European Heart Journal: Cardiovascular Imaging. 2020; 21: 768-776. doi:10.1093/ehjci/jez267.
13. Fortuni F, Dietz MF, Prihadi EA, et al. Prognostic Implications of a novel algorithm to grade secondary tricuspid regurgitation. JACC: Cardiovascular Imaging. 2021; 14: 1085-1095. doi:10.1016/j.jcmg.2020.12.011.
14. Erlikh AD, Barbarash OL, Berns SA, et al. SIRENA score for in-hospital mortality risk assessment in patients with acute pulmonary embolism. Russian Journal of Cardiology. 2020; 25(4S): 4231. (In Russ.) doi: 10.15829/1560-4071-2020-4231.
15. Sivukhin DV. General course of physics. Volume I. Mechanics. Textbook for universities. Moscow: Fizmatlit, 2020. 560 p. (In Russ.)
16. Shapak AA. Hydraulics and hydraulic pneumatic drive. Fundamentals of fluid and Gas Mechanics. 6th ed. Moscow: INFRA-M; 2017. 271 p. (In Russ.)
17. Yevlakhov VI, Pugovkin AP, Rudakova TL, Shalkovskaya LN. Introduction to the physiology of the heart. St. Petersburg: SpetsLit, 2019. 311 p. (In Russ.)
18. Netylko J, Teterina M, Pisaryuk A, et al. Prognostic value of echocardiographic parameters in patients with pulmonary embolism. Klinicheskaya farmakologiya i terapiya. 2021; 30(3): 52-56. (In Russ.) doi: 10.32756/0869-5490-2021-3-52-56.
19. Dahou A, Ong G, Hamid N, et al. Quantifying tricuspid regurgitation severity: a comparison of proximal isovelocity surface area and novel quantitative doppler methods. JACC: Cardiovascular Imaging. 2019; 12: 560-562. doi: 10.1016/j.echo.2020.05.007.
20. Lyhne MD, Kabrhel C, Giordano N, et al. The echocardiographic ratio tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure predicts short-term adverse outcomes in acute pulmonary embolism. Eur Heart J Cardiovasc Imaging. 2021; 22(3): 285-294. doi: 10.1093/ehjci/ jeaa243.
