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Open AccessArticle

Incremental Value of ePLAR—The Echocardiographic Pulmonary to Left Atrial Ratio in the Assessment of Sub-Massive Pulmonary Emboli

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Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia
2
Department of Medicine, University of Queensland, Brisbane, QLD 4032, Australia
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The Prince Charles Hospital, Brisbane, QLD 4032, Australia
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Redcliffe District Hospital, Redcliffe, QLD 4032, Australia
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The Wesley Hospital, Brisbane, QLD 4066, Australia
6
Genesis Care, Auchenflower, QLD 4066, Australia
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(1), 247; https://doi.org/10.3390/jcm9010247
Received: 13 December 2019 / Revised: 10 January 2020 / Accepted: 13 January 2020 / Published: 17 January 2020
(This article belongs to the Section Pulmonology)
Background: Acute pulmonary embolism (PE) is characterized hemodynamically by abrupt obstruction in trans-pulmonary blood flow. The echocardiographic Pulmonary to Left Atrial ratio (ePLAR, tricuspid regurgitation Vmax/mitral E/e’) has been validated as a non-invasive surrogate for trans-pulmonary gradient (TPG) that accurately differentiates pre-capillary from post-capillary chronic pulmonary hypertension. This study assessed ePLAR as an incremental echocardiographic assessment tool compared with traditional measures of right ventricular pressure and function. Methods: In total, 110 (57.4 ± 17.6 years) patients with confirmed sub-massive pulmonary emboli with contemporaneous echocardiograms (0.3 ± 0.9 days) were compared with 110 age-matched controls (AMC). Results: Tricuspid velocities were higher than AMC (2.6 ± 0.6 m/s vs. 2.4 ± 0.3 m/s, p < 0.05), although still consistent with “normal” right ventricular systolic pressures (34.2 ± 13.5 mmHg vs. 25 ± 5.3 mmHg, p < 0.05) with lower mitral E/e’ values (8.2 ± 3.8 vs. 10.8 ± 5.1, p < 0.05). ePLAR values were higher than AMC (0.36 ± 0.14 m/s vs. 0.26 ± 0.10, p < 0.05) suggesting significantly elevated TPG. Detection of abnormal echocardiographic findings increased from 29% (TRVmax ≥ 2.9 m/s) and 32% (reduced tricuspid annular plane systolic excursion) to 70% with ePLAR ≥ 0.3 m/s. Conclusions: Raised ePLAR values in acute sub-massive pulmonary embolism suggest elevated trans-pulmonary gradients even in the absence of acutely increased pulmonary artery pressures. ePLAR dramatically increases the sensitivity of echocardiography for detection of hemodynamic perturbations in sub-massive pulmonary embolism patients, which may offer clinical utility in diagnosis and management. View Full-Text
Keywords: pulmonary embolus; echocardiography; ePLAR pulmonary embolus; echocardiography; ePLAR
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Scalia, I.G.; Scalia, W.M.; Hunter, J.; Riha, A.Z.; Wong, D.; Celermajer, Y.; Platts, D.G.; Fitzgerald, B.T.; Scalia, G.M. Incremental Value of ePLAR—The Echocardiographic Pulmonary to Left Atrial Ratio in the Assessment of Sub-Massive Pulmonary Emboli. J. Clin. Med. 2020, 9, 247.

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