ECHOCARDIOGRAPHIC ASSESSMENT OF RIGHT-SIDED HEART IN PATIENTS WITH PULMONARY EMBOLISM

Background: Pulmonary embolism (PE) is a life-threatening cardiovascular emergency caused by thrombi from the deep veins of the lower extremities blocking the pulmonary arteries. Early RV function evaluation is crucial for risk classification and therapy since RV dysfunction is connected to unfavorable outcomes. Two-dimensional (2D) echocardiography uses TAPSE, pulmonary artery pressures, the 60:60 sign, and McConnell's sign to quickly assess RV function at bedside. Aim: To investigate the role of 2D echocardiography in induced pulmonary embolism patients by measuring TAPSE as a mortality risk predictor, right heart and pulmonary architecture, the 60:60 sign, and RV contractility with a focus on McConnell's sign. Patients and Methods: This observational cross-sectional study was conducted in the intensive care unit of Baghdad Teaching Hospital between January and April 2024. Forty adult patients with CT-confirmed provoked pulmonary embolism were enrolled. Comprehensive echocardiographic assessment was performed using a GE Vivid E9 system, including measurements of TAPSE, RV size and function, tricuspid regurgitation (TR), pulmonary trunk diameter, inferior vena cava (IVC) size and collapsibility, and the presence of McConnell’s and 60:60 signs. Demographic and clinical data were collected using a structured questionnaire. Statistical analysis was carried out with SPSS version 26, with significance set at p ≤ 0.05. Results: The mean age of patients was 44.4 years, and 80% were female. Impaired TAPSE was observed in 50% of patients. McConnell’s sign was present in 30%, and the 60:60 sign in 20%, both significantly associated with RV dysfunction. RV dilatation and IVC non-collapsibility were strongly linked to reduced TAPSE. A significant negative correlation was identified between TAPSE and the severity of tricuspid regurgitation. Conclusion: Provoked pulmonary embolism is frequently associated with significant right ventricular dysfunction. TAPSE, together with McConnell’s sign and the 60:60 sign, provides valuable prognostic information and should be routinely assessed in PE patients.