Abstract 10293: Regional Right Ventricular Dysfunction in Acute Pulmonary Embolism Associated With Increased Clot Burden and Greater RV Dysfunction

Introduction: Regional right ventricular (RV) dysfunction (RRVD) is an echocardiographic feature in acute pulmonary embolism (PE), primarily reported in patients with moderate-to-severe RV dysfunction. We assessed the hypothesis that RRVD is associated with increased burden of PE and greater RV dysfunction. Methods: We identified all consecutive patients admitted at Stanford’s emergency department between 1999 and 2014 who underwent both computed tomographic angiography, echocardiography, and biomarker testing (troponin and NT-proBNP) within 2 days of each other for suspected acute PE, in order to investigate the relationship between RRVD, PE clot burden, RV size/function, and biomarkers. Patients with PE were divided according to clot burden as follows: central or multilobar PE versus peripheral PE. RRVD was defined as normal excursion of the apex contrasting with hypokinesis of the mid-free wall segment. RV function was assessed by fractional area change and free-wall longitudinal strain. Echocardiograms were also assessed for reproducibility. Results: Eighty-two patients were included (mean age 66 ±17 years, 43% male, 51 with acute PE). RRVD was present in 41% of PEs and absent in all patients without PE. Eighty-six percent (86%) of patients with RRVD had central or multi-lobar PE. Patients with RRVD had higher prevalence of moderate-to-severe RV dilation (81% vs. 30%, p<0.01) and dysfunction (86% vs. 23%, p<0.01). Troponin level was positive in 38% of patients with RRVD versus 13% in PE without RRVD (p=0.08), while the NT-proBNP level was positive in 67% versus 73% (p=0.88), respectively. RRVD showed excellent concordance between readers (87%). Conclusion: The “McConnell sign” of RRVD is a reproducible finding associated with an increased clot burden and greater degree of RV dysfunction in patients with acute PE.