CONTRACTILE FUNCTION OF THE RIGHT VENTRICLE IN PATIENTS WITH ACUTE MASSIVE PULMONARY EMBOLISM AND ITS CHANGES AFTER ENDOVASCULAR MECHANICAL FRAGMENTATION WITH LOCAL THROMBOLYSIS
The prognosis, outcome and optimal treatment of patients with acute pulmonary embolism depend on the state of systemic hemodynamics. Patients with shock, hypotension, have a much higher mortality rate than patients with stable hemodynamics. Echocardiographic signs of RV dysfunction and positive cardiac biomarkers in acute PE are independent predictors of adverse outcome of disease in patients with stable hemodynamics and are associated with increased risk of early mortality. Recent data show that in patients with acute pulmonary embolism of an intermediate high early death risk it is possible to use more aggressive therapy than the anticoagulant, thrombolytic therapy. Echocardiographic signs of dysfunction were accepted as independent predictors of adverse outcome, even in hemodynamically stable patients with acute pulmonary embolism, in which the early (30 - day) mortality rate reaches 13%. Most authors include in echocardiography signs of RV dysfunction: dilation of the RV (RV end-diastolic dimension > 30 mm) or increased ratio of RV / LV diameter > 1, the presence of paradoxical systolic motion of the interventricular septum (IVS), hypokinesia (akinesia) of free RV wall (McConnell sign), increased jet velocity of tricuspid regurgitation (TR > 2.8 m / s), pulmonary hypertension (pressure gradient > 30 mm Hg) or a combination of the above mentioned symptoms. The article describes the experience of treatment of 110 patients with acute massive pulmonary embolism by endovascular mechanical fragmentation (EMF) with local thrombolysis. The study analyzed the diagnostic echocardiographic signs of right ventricular (RV) dysfunction. The method of Bayesian logistic regression model revealed dysfunction of RV by transthoracic echocardiography, which makes the greatest contribution to the development of right ventricular contractile dysfunction.