Relationship Between The Degree Of Pulmonary Artery Obstruction And Echocardiographic Parameters In Patients With Pulmonary Thromboembolism

BACKGROUNDVenous thromboembolism clinically presents as a pulmonary embolism or deep vein thrombosis. Pulmonary embolism presents as acute pulmonary obstruction caused by an embolus, and in 95 % of cases the embolus originates from the deep veins of the lower extremity, most often the popliteal vein and veins above it, or from the venous plexuses of the pelvis, while the rest present emboli from the right heart cavities, some other veins and in situ pulmonary artery thrombosis.METHODSThis is a prospective study conducted among 52 consecutive patients who were hospitalised at the Department of Cardiology, Clinic for Heart, Blood Vessel and Rheumatic Diseases, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina, from January 2017 April 2019, diagnosed with pulmonary thromboembolism. Pulmonary artery obstruction index was calculated based on computed tomography (CT), and pulmonary angiography. Transthoracic echocardiography was performed for each patient to assess the degree of tricuspid regurgitation, right ventricle systolic pressure, right heart cavities dimension - right ventricle and right atrium, ejection fraction, D-dimer and left ventricular internal diameter end diastole.RESULTSThere was statistically significant difference between pulmonary artery obstruction scores and echocardiographic parameters including severity of the degree of tricuspid regurgitation, dimensions of the right atrium, right ventricle dimensions and right ventricular pressure values. In this study 19 % of patients had normal values of pulmonary hypertension (mean rank = 11.95) compared to 28 % of patients with severe (mean rank = 32.15) and very severe pulmonary hypertension. There was statistically significant correlation between pulmonary artery obstruction scores and D-dimer, tricuspid regurgitation, and between pulmonary artery obstruction index (PAOI) scores and right ventricular pressure. Tricuspid regurgitation has the highest correlation with PAOI score.CONCLUSIONSLevel of pulmonary obstruction via pulmonary artery obstruction score in patients with pulmonary embolism can be a useful parameter which is easy to calculate and can be used as a leverage in the assessment of severity of condition in patients with pulmonary embolism as well as a method for evaluation of prognostic outcome.