Assessment of Right and Left Ventricular Diastolic Functions with Tissue Doppler Echocardiography in Congestive Heart Failure Patients with Coexisting Acute Pulmonary Embolism

BACKGROUND: Acute pulmonary embolism (APE), despite improvements in diagnostic methods, often remains undiagnosed. Recently, systolic dysfunction has also been described as assessed by new echocardiographic techniques, such as tissue Doppler imaging (TDI). OBJECTIVES: In our study we have attempted to assess diastolic function within the mitral and tricuspid annuli in congestive heart failure (CHF) patients with coexisting APE. MATERIAL AND METHODS: The study included 39 patients with CHF with sinus rhythm, 20 patients with confirmed APE (PE+), and 19 patients with excluded APE (PE-). APE was confirmed or excluded on the result of spiral chest computed tomography. Tissue Doppler imaging (TDI) was performed to measure early diastolic velocity (Em), late diastolic velocity (Am) of both examined annuli, and Em/AmLV and Em/AmRV ratios. RESULTS: PE+ subjects were found to have lower EmRV than PE- subjects [4.2 (2.0-14) vs. 6.5 (0.8-14) cm/s; p = 0.006]. The AmLV was higher in the PE+ vs. PE- group [8.4 (3.0-15.2) vs. 3.0 (1.0-14.8), p = 0.0038]. Em/AmLV and Em/AmRV were significantly lower in the PE + vs. PE- group [0.55 (0.2-1.4) vs. 1.6 (0.16-5.4), p = 0.0089 and 0.41 (0.17-2.5) vs. 1.5 (0.05-5.5), p = 0.0069]. For the APE diagnosis, the area under the ROC curve calculated for AmLV and Em/AmLV was 0.771 (95% CI 0.509-0.890) and 0.742 (95% CI 0.577-0.868) respectively. For the APE diagnosis, the sensitivity, specificity, positive and negative predictive values for AmLV = 4.9 cm/s were: 95%, 68.4%, 76% and 92.9%, respectively and for Em/AmLV = 1.0 were: 95%, 63.2%, 73.1% and 92.3%, respectively. CONCLUSIONS: TDI reveals changes in mitral and tricuspid annular velocities in CHF patients with confirmed APE. These patients exhibit a reduced EmRV and increased AmLV.