Key result
Echocardiography in patients with pulmonary tumor thrombotic microangiopathy demonstrated moderate-to-severe right ventricular dilatation and severe pulmonary hypertension (median RV systolic pressure 63 mmHg).
Why the study?
Pulmonary tumor thrombotic microangiopathy (PTTM) is a fatal disease obstructing pulmonary vessels and causing rapid progressive dyspnea in patients with cancer, but its echocardiographic presentation in emergency department diagnoses needs characterization.
What are the echocardiographic characteristics of patients with pulmonary tumor thrombotic microangiopathy presenting to the emergency department?
Observational (n=9)
No
What are the echocardiographic characteristics of patients with pulmonary tumor thrombotic microangiopathy presenting to the emergency department?
Echocardiography reveals severe pulmonary hypertension and right ventricular failure in cancer patients with acute dyspnea, aiding in the rapid emergency department diagnosis of pulmonary tumor thrombotic microangiopathy.
Pulmonary tumor thrombotic microangiopathy (PTTM) is a fatal disease that obstructs pulmonary vessels, leading to pulmonary hypertension (PH) and right-sided heart failure causing rapid progressive dyspnea in patients with cancer. This retrospective chart review involved nine patients with PTTM who were first clinically diagnosed in a tertiary emergency department (ED) between January 2015 and June 2021. They underwent laboratory tests, chest radiography, chest computed tomography (CT), and echocardiography. All patients presented with severe and rapidly progressive dyspnea within a few days, a high oxygen demand. The right ventricle (RV): left ventricle ratio was >1 on chest CT, and no life-threatening pulmonary thromboembolism (PTE) was observed. Echocardiographic findings indicated that all patients had moderate-to-severe RV dilatation with a D-shaped LV. The median tricuspid regurgitation maximum velocity was 3.8 m/s, and the median RV systolic pressure was 63 mmHg, indicating severe PH. The median value of tricuspid annular plane systolic excursion was 15 mm, showing a decrease in RV systolic function, and McConnell's sign was observed in five patients. Two patients immediately underwent chemotherapy and are currently alive. PTTM should be suspected and evaluated using echocardiography in patients with cancer presenting to the ED with acute dyspnea and RV failure without PTE.
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Yoon et al. (2022) conducted an observational in Pulmonary tumor thrombotic microangiopathy (PTTM) (n=9). Echocardiography was evaluated on Echocardiographic findings of right ventricular function and pulmonary hypertension. Echocardiography in patients with pulmonary tumor thrombotic microangiopathy demonstrated moderate-to-severe right ventricular dilatation and severe pulmonary hypertension (median RV systolic pressure 63 mmHg).
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