Bettina-Maria Taute, Hendrik Schmidt, Andreas Gunter Bach, Ronald Fischer, Christin Le Hoa Tran, Mroawan Amoury and Hannes Melnyk
Background Changes of central and peripheral venous hemodynamics (PVH) are registered in patients with acute pulmonary embolism (PE) with right ventricular dysfunction (RVD). It can be assumed the change of PVH is detectable through spectral Doppler waveform analysis of the common femoral veins (CFV) and regular respiratory modulated (RM) flow is replaced as a function of the severity of the RVD by cardiac modulation (CM) of the velocity-time spectra. The aim of this study is to examine, through detection of CM at the CFV, whether indirect diagnostics of the RVD is possible in patients with acute PE. Methods Quantification of RVD was performed through an echocardiographic right heart score (RHS) in patients with acute PE. The RHS integrated four parameters: the size of the right ventricle, the RV kinetics, the motion of the interventricular septum and the right atrial size. The sonographic quantification of RM and CM at the CFV was performed through measurement of the flow duration directed towards the heart in the velocity-time spectrum. The results of the RHS and the respective spectral Doppler waveform at the CFV were comparatively analysed. Results In 47 acute PE-patients CM was found in 53.2%. A RHS of 1 was present in 17% and there was no CM. CM was found in 19% of patients with a RHS of 1.25, and in 92% of patients with a RHS of 1.5. All patients with a RHS of ≥ 1.75 had a CM. The sensitivity and specificity for the CM with a cut-off RHS of 1.5 amounted to 0.96 and 0.88 respectively. Conclusion The CM at the CFV is an indirect diagnostic criterion of RVD with acute PE. In the case of suspected PE, the absence of CM excludes a RVD. Disappearance of CM during the clinical course of PE indicates improvement in RV function.
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