Agreement between transthoracic echocardiography and computed tomography pulmonary angiography for detection of right ventricular failure

New ERS/ESC guidelines recommend assessment of right ventricular dysfunction (RVD) with transthoracic echocardiography (TTE) or computed tomography pulmonary angiography (CTPA) in patients with pulmonary embolism (PE). In this retrospective study, we investigated the agreement between TTE and CTPA for the detection of RVD. PE patients who underwent TTE within 24 hours after diagnosis were enrolled. Patients with a history of pulmonary hypertension, NYHA class IV heart failure and acute PE on chronic thromboembolic pulmonary hypertension were excluded. CTPA signs of RVD were defined as RV/LV ≥1, flattening/bulging of the interventricular septum (IVS), contrast reflux to inferior vena cava. TTE findings were defined as the enlarged right ventricle, flattened IVS, RV hypo/akinesia, pulmonary arterial systolic pressure ≥40 mmHg or right heart thrombus. 199 patients met the inclusion criteria. In 143 patients (71.9%) CTPA and TTE agreed on whether RVD was present or not. In 43 patients (21.6%), TTE was normal but CTPA showed RVD. In 13 (6.5%) patients, CTPA was normal but TTE showed RVD. There was a fair agreement between the two tests (Cohen’s Kappa=0.394). 17 patients died; 3 due to PE and both TTE and CTPA revealed RVD in these 3 patients. Remaining 14 died due to comorbidities. 13 had RVD on TTE and normal CTPA, 1 had normal TTE but RVD on CTPA. In conclusion, CTPA reported more RVD dysfunction than TTE in our cohort. This might be due to higher specificity of TTE.