Indexing of Speckle Tracking Longitudinal Strain of Right Ventricle to Body Surface Area Does Not Improve Its Efficiency in Diagnosis and Mortality Risk Stratification in Patients with Acute Pulmonary Embolism
Abstract
:1. Introduction
2. Material and Methods
2.1. Methodology
2.2. Statistical Analysis
3. Results
3.1. Course of the Study
3.2. Echocardiographic Parameters
3.3. Analysis of Predictors of 30-Day All-Cause Mortality
4. Discussion
5. Conclusions
6. Study Limitation
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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All Subjects (n = 167) | Patients with No PE (n = 79) | Patients with PE (n = 88) | p | Survivors (n = 76) | Non-Survivors (n = 12) | p | |
---|---|---|---|---|---|---|---|
Gender [male] | 76 (45.51%) | 32 (40.51%) | 44 (50%) | 0.36 | 41 (53.95%) | 3 (25%) | 0.12 |
Age [years] | 69 (59.50–79.08) | 70 (61.21–78.51) | 69 (58.14–79.37) | 0.95 | 66 (56.75–77.50) | 74.5 (69–89.25) | 0.01 |
BMI [kg/m2] | 27.55 (23.84–31.08) | 26.61 (22.39–29.47) | 28.22 (25.97–31.25) | 0.02 | 28.34 (26.07–31.25) | 27.3 (23.93–30.99) | 0.46 |
Arterial hypertension | 102 (61.08%) | 50 (63.29%) | 52 (59.09%) | 0.64 | 46 (60.53%) | 6 (50%) | 0.49 |
Hyperlipidemia | 72 (43.11%) | 39 (49.37%) | 33 (37.5%) | 0.08 | 29 (38.16%) | 4 (33.33%) | 1 |
Diabetes mellitus | 38 (22.75%) | 18 (22.78%) | 20 (22.73%) | 0.72 | 17 (22.37%) | 3 (25.00%) | 1 |
Coronary artery disease | 44 (26.35%) | 28 (35.44%) | 16 (18.18%) | 0.01 | 15 (19.74%) | 1 (8.33%) | 0.69 |
Chronic heart failure | 51 (30.54%) | 30 (37.97%) | 21 (23.86%) | 0.01 | 18 (23.68%) | 3 (25%) | 0.76 |
Atrial fibrillation (present or prior) | 21 (12.57%) | 10 (12.66%) | 11 (12.50%) | 0.28 | 9 (11.84%) | 2 (16.67%) | 0.64 |
Chronic lung disease | 17 (10.18%) | 10 (12.66%) | 7 (7.95%) | 0.09 | 6 (7.89%) | 1 (8.33%) | 1 |
Active malignancy | 38 (22.75%) | 19 (24.05%) | 19 (21.59%) | 0.67 | 16 (21.05%) | 3 (25.00%) | 0.69 |
Acute infection | 65 (38.92%) | 31 (39.24%) | 34 (38.64%) | 0.29 | 28 (36.84%) | 6 (50.00%) | 0.38 |
PESI [pts] | 94 (79–116) | 94 (79–117) | 94 (78–115) | 0.42 | 90 (70–107) | 136 (113–173) | <0.001 |
Troponin T [pg/mL] | 21.51 (11.53–45.75) | 21.74 (13.14–48.81) | 20.87 (10.73–45.61) | 0.56 | 18.84 (9.20–44.57) | 70.29 (28.62–136.08) | 0.01 |
NT-proBNP [pg/mL] | 811.00 (196.00–3119.00) | 878.00 (229.00–3950.00) | 627.50 (152.00–2878.00) | 0.30 | 548.00 (142.00–2631.00) | 2984.00 (1711.00–7791.00) | 0.02 |
D-dimer [ng/mL] | 3697.00 (1990.00–6998.00) | 2898.00 (1721.00–4805.00) | 4792.00 (2657.00–7801.00) | <0.001 | 4792.00 (2348.00–7801.00) | 4737.00 (4280.00–7499.00) | 0.62 |
Creatinine clearance [mL/min] | 82.00 (62.12–104.47) | 81.55 (60.25–102.60) | 83.3 (67.07–106.12) | 0.47 | 84.40 (69.35–104.97) | 70.65 (42.50–132.15) | 0.54 |
Patients with No PE (n = 79) | Patients with PE (n = 88) | p | Survivors (n = 76) | Non-Survivors (n = 12) | p | |
---|---|---|---|---|---|---|
RVTD [mm] | 38.25 (35.17–42.43) | 40.11 (37.06–43.16) | 0.048 | 41.35 (37.49–43.25) | 38.11 (35.75–42.23) | 0.30 |
LVTD [mm] | 43.65 (38.22–49.85) | 44.33 (39.05–47.09) | 0.98 | 44.21 (40.16–48.68) | 40.29 (35.51–44.09) | 0.06 |
RVTD/LVTD | 0.88 (0.77–1.03) | 0.93 (0.84–1.05) | 0.11 | 0.93 (0.83–1.04) | 1 (0.89–1.08) | 0.38 |
Act [ms] | 95.04 (74.11–111.82) | 72.41 (57.75–96.22) | <0.001 | 74.16 (58.75–98.88) | 59.07 (47.50–72.51) | 0.07 |
TRPG [mm Hg] | 2.72 (2.30–3.16) | 2.74 (2.31–3.13) | 0.86 | 2.75 (2.36–3.11) | 2.72 (2.11–3.25) | 0.94 |
TAPSE [mm] | 22.14 (17.09–25.76) | 21.45 (17.55–24.25) | 0.78 | 22.07 (18.19–25.25) | 18.50 (15.75–20.04) | 0.06 |
TASV TDI [cm/s] | 16.33 (12.11–20.44) | 15.20 (13.07–19.23) | 0.87 | 15.23 (13.17–18.51) | 19.04 (14.52–20.55) | 0.14 |
McConnell sign | 1 (1.27%) | 10 (11.36%) | 0.01 | 9 (11.84%) | 1 (8.33%) | 1 |
LVEF [%] | 56.31 (48.52–65.04) | 56.15 (50.41–63.17) | 0.93 | 55.52 (50.07–63.44) | 56.22 (48.54–62.56) | 0.95 |
RV FAC [%] | 46.58 (37.14–51.36) | 40.26 (31.03–48.33) | 0.31 | 40.26 (29.69–49.17) | 39.13 (37.16–41.10) | 0.81 |
LVGLS [%] | 16.90 (13.31–19.75) | 17.20 (14.02–19.85) | 0.49 | 17.21 (14.52–19.65) | 16.61 (13.07–20.95) | 0.93 |
RVOT PLAX [mm] | 30.00 (27.00–32.00) | 30.00 (28.50–34.00) | 0.22 | 31.00(28.00–34.00) | 28.00 (26.00–33.00) | 0.13 |
RVOT SAX diastolic [mm] | 32.00 (28.00–35.75) | 32.00 (29.00–35.00) | 0.76 | 32.00 (29.00–36.00) | 30 (29.00–32.50) | 0.10 |
RVOT SAX systolic [mm] | 20.00 (17.00–25.75) | 19.50 (16.00–24.00) | 0.82 | 20.00 (16.00–25.00) | 19 (16.00–22.75) | 0.53 |
Segments | Patients with No PE (n = 79) | Patients with PE (n = 88) | p | Survivors (n = 76) | Non-Survivors (n = 12) | p |
---|---|---|---|---|---|---|
RV strain original values [%] | ||||||
RVFW basal | 23.00 (16.00–25.00) | 21.00 (14.00–26.00) | 0.45 | 21.00 (16.75–27.00) | 13.00 (9.50–21.25) | 0.03 |
RVFW mid | 22.00 (17.50–28.00) | 20.00 (14.75–25.00) | 0.03 | 20.00 (16.00–25.00) | 15 (10.75–23.50) | 0.18 |
RVFW apical | 18.00 (12.00–25.00) | 18.00 (14.00–23.25) | 0.84 | 18.00 (14.00–23.25) | 17.00 (8.00–21.25) | 0.41 |
SEP basal | 16.00 (10.00–19.00) | 17.00 (11.00–21.00) | 0.10 | 17.00 (11.75–21.00) | 13.5 (8.25–16.25) | 0.049 |
SEP mid | 18.00 (13.00–21.00) | 17.00 (13.75–20.50) | 0.78 | 17.00 (14.00–22.00) | 15.00 (12.50–20.00) | 0.32 |
SEP apical | 16.00 (11.50–22.00) | 16.00 (13.75–22.25) | 0.40 | 16.00 (14.00–22.00) | 16.50 (6.75–23.00) | 0.58 |
RVFW-average of 3 segments | 19.67 (14.83–25.83) | 18.5 (15.33–22.92) | 0.43 | 19 (15.67–22.92) | 16.67 (10.75–22.58) | 0.32 |
RVGLS | 18.50 (14.17–22.08) | 17.75 (14.46–21.5) | 0.64 | 18 (14.88–21.12) | 16 (10.62–22.58) | 0.23 |
RV strain indexed to BSA [%/m2] | ||||||
RVFW basal | 11.52 (8.88–14.65) | 11.26 (7.53–13.59) | 0.13 | 11.49 (7.85–13.67) | 7.34 (4.9–10.87) | 0.08 |
RVFW mid | 12.27 (9.02–15.76) | 10.12 (7.4–12.96) | 0.01 | 10.17 (7.71–12.92) | 7.29 (5.63–13.86) | 0.37 |
RVFW apical | 10.16 (6.71–13.39) | 9.39 (6.89–11.99) | 0.36 | 9.39 (7.15–11.89) | 8.65 (4.95–12.08) | 0.56 |
SEP basal | 8.36 (5.49–10.53) | 8.47 (5.72–10.77) | 0.53 | 8.53 (6.11–10.98) | 7.06 (4.7–9.79) | 0.23 |
SEP mid | 9.92 (7.28–11.98) | 8.56 (6.82–11.34) | 0.24 | 8.51 (6.96–11.34) | 9.02 (5.93–10.9) | 0.97 |
SEP apical | 8.65 (6.04–12.23) | 8.55 (6.6–11.78) | 0.96 | 8.55 (6.66–11.78) | 9.12 (3.25–12.09) | 0.77 |
RVFW-average of 3 segments | 10.20 (7.89–14.38) | 9.43 (7.51–12.03) | 0.12 | 9.67 (7.63–11.88) | 8.62 (5.86–12.37) | 0.61 |
RVGLS | 9.71 (7.71–12.59) | 8.81 (7.5–11.51) | 0.22 | 8.81 (7.61–11.51) | 8.51 (5.85–11.55) | 0.66 |
AUC | p | Youden Cut-off | Sensitivity | Specificity | |
---|---|---|---|---|---|
Age [years] | 0.74 (0.61, 0.87) | 0.004 | 66 | 1 (0.74–1) | 0.49 (0.37–0.6) |
BMI [kg/m2] | 0.63 (0.54, 0.72) | 0.002 | 24.7 | 0.82 (0.72–0.89) | 0.44 (0.33–0.56) |
PESI [pts] | 0.88 (0.80, 0.96) | <0.001 | 100 | 1 (0.74–1) | 0.7 (0.59–0.8) |
D-dimer [pg/mL] | 0.66 (0.57, 0.75) | <0.001 | 3559 | 0.7 (0.58–0.79) | 0.6 (0.48–0.71) |
Troponin T [ng/mL] | 0.78 (0.60, 0.95) | 0.005 | 66 | 0.62 (0.24–0.91) | 0.88 (0.78–0.94) |
NT-proBNP [pg/mL] | 0.75 (0.58, 0.92) | 0.01 | 1120 | 0.89 (0.52–1) | 0.62 (0.5–0.73) |
RVFW basal LS [%] | 0.70 (0.54, 0.86) | 0.02 | −14 | 0.58 (0.28–0.85) | 0.78 (0.67–0.86) |
SEP basal LS [%] | 0.68 (0.49, 0.86) | 0.02 | −15 | 0.5 (0.21–0.79) | 0.67 (0.55–0.77) |
RVFW mid LS [%] | 0.60 (0.51, 0.69) | 0.01 | −21 | 0.61 (0.5–0.72) | 0.54 (0.43–0.66) |
RVFW mid LS/ BSA [%/m2] | 0.62 (0.54, 0.71) | 0.003 | −14 | 0.84 (0.75–0.91) | 0.39 (0.28–0.51) |
Act [ms] | 0.67 (0.59, 0.75) | <0.001 | 67 | 0.48 (0.37–0.59) | 0.82 (0.72–0.9) |
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Wiliński, J.; Skwarek, A.; Borek, R.; Medygrał, M.; Chrzan, I.; Lechowicz-Wilińska, M.; Chukwu, O. Indexing of Speckle Tracking Longitudinal Strain of Right Ventricle to Body Surface Area Does Not Improve Its Efficiency in Diagnosis and Mortality Risk Stratification in Patients with Acute Pulmonary Embolism. Healthcare 2023, 11, 1629. https://doi.org/10.3390/healthcare11111629
Wiliński J, Skwarek A, Borek R, Medygrał M, Chrzan I, Lechowicz-Wilińska M, Chukwu O. Indexing of Speckle Tracking Longitudinal Strain of Right Ventricle to Body Surface Area Does Not Improve Its Efficiency in Diagnosis and Mortality Risk Stratification in Patients with Acute Pulmonary Embolism. Healthcare. 2023; 11(11):1629. https://doi.org/10.3390/healthcare11111629
Chicago/Turabian StyleWiliński, Jerzy, Anna Skwarek, Radosław Borek, Michał Medygrał, Iwona Chrzan, Marta Lechowicz-Wilińska, and Ositadima Chukwu. 2023. "Indexing of Speckle Tracking Longitudinal Strain of Right Ventricle to Body Surface Area Does Not Improve Its Efficiency in Diagnosis and Mortality Risk Stratification in Patients with Acute Pulmonary Embolism" Healthcare 11, no. 11: 1629. https://doi.org/10.3390/healthcare11111629