The role of tissue colour Doppler imaging in diagnosis of segmental pulmonary embolism in congestive heart failure patients

Background: Tissue Doppler imaging enables qualitative and quantitative assessment of myocardial function of the left and right ventricles. Aim: To compare systolic longitudinal mitral and tricuspid annular velocities in a congestive heart failure (CHF) patient group with clinical suspicion of pulmonary embolism (PE). Methods: Fifty-five consecutive CHF patients with a history of abrupt onset of resting dyspnoea, elevated > 35 mmHg right ventricular systolic pressure (RVSP) and positive D-dimer test were included in the study. Patients underwent standard echocardiography and tissue colour Doppler imaging with post-processing analysis (Echopack 6.3, GE Vingmed) and spiral computed tomography (SCT) within 24 hours from admission. Mitral and tricuspid annular longitudinal systolic and diastolic velocities were measured at their lateral sites in a 4-chamber apical view. According to the results of the SCT examination patients were classified into groups: PE positive (group 1 - 25 patients) and PE negative (group 2 - 30 patients). Results: Tricuspid annular lateral systolic velocity (SmRV) was 6.5 +/- 2.6 cm/s in group 1 and 7.0 +/- 2.5 cm/s in group 2 (p=NS). Mitral annular lateral systolic velocity (SmLV) was 6.4 +/- 3.0 cm/s and 4.3 +/- 2.0 cm/s in group 1 and group 2 respectively (p = 0.003). Patients diagnosed as PE cases showed statistically significant higher mitral annular lateral systolic velocity. Using a cut-off value of > 5.5 cm/s derived from receiver operating characteristics curve analysis, patients were separated from those without PE with sensitivity of 60% and specificity of 86.7%. The ratio of SmRV/SmLV was 1.1 +/- 0.4 and 1.73 +/- 0.87 in group 1 and group 2, respectively (p=0.001). Using a cut-off value ratio of <= 1.2 derived from receiver operator characteristic curve analysis, patients were separated from those without PE with a sensitivity of 76% and a specificity of 93.3%. Conclusion: Mitral annular lateral systolic velocity above 5.5 cm/s and ratio of systolic lateral tricuspid annular velocity to systolic lateral mitral annular velocity <= 1.2 are useful parameters of pulmonary embolism in congestive heart failure patients.