141 Usefulness of tricuspid annular displacement (TAD) to identify right ventricular dysfunction in normotensive patients with acute pulmonary embolism

Echocardiographic criteria of right ventricular dysfunction (RVD) in acute pulmonary embolism (PE) differ among published studies. Assessment of RV systolic function remains difficult because of the RV's complex shape. We aimed to evaluate RV systolic function with TAD in patients (pts) with acute PE. TAD (QLAB, Philips Medical Imaging) was based on a tissue tracking algorithm that is ultrasound beam angle independent for automated detection of tricuspid annular displacement. Methods All adults pts who were diagnosed with PE from december 2008 to march 2009 at Princesse Grace Hospital, Monaco were eligible for this study after exclusion of history of heart failure. We evaluated 22 consecutive pts with PE (12 male, mean age 62,2 years) which underwent echocardiography, plasma BNP titration during the first day after admission, and a second echocardiography obtained within 48 hours before discharge. Results TAD showed significant positive correlation with RV FAC (R 2 = 0,49; p= 0,0003) and Sa (R 2 = 0,43 ; p= 0,001). Among pts with PE who presented signs of RVD, TAD value was 12.5 +/–5.4 mm vs 15.9 +/–2.7mm (p=0.05). TAD value was 17 +/– 4.2mm when BNP level was less than 80 pg/mL vs 11.1 +/– 3.7 (p= 0.007) among pts who had BNP level > 80 pg/mL. After treatment, follow-up echocardiographic data were obtained from 21 pts (mean: 8.8+/-3.6 days). Mean pulmonic valve acceleration time, Sa and TAD were significantly improved (p In conclusion impaired TAD was associated with decreased RV systolic function in pts with acute PE. To identify the clinical meaning of decreased TAD, larger trials with longer follow-up periods are needed.