Chest
Volume 65, Issue 5, May 1974, Pages 534-543
Journal home page for Chest

Original Investigations
Determinants of Right Ventricular Function and Hemodynamics after Pulmonary Embolism

https://doi.org/10.1378/chest.65.5.534Get rights and content

The purpose of this study was to examine the relative contributions of pulmonary embolic obstruction and independent pre-embolic cardiopulmonary disease to the postembolic cardiovascular status. Of 36 patients studied, 28 had underlying heart or lung disease, while 8 patients had had neither. The extent of pulmonary embolic obstruction was determined by pulmonary angiography. No relationship could be found between the degree of cardiovascular and right ventricular functional impairment and the severity of pulmonary embolic obstruction in the group as a whole. These findings were in contrast with the dose relationship which has been shown to exist between the severity of cardiovascular impairment and the extent of embolic obstruction in patients free of pre-existing heart and rang disease. Increasingly severe impairment of right ventricular function was associated with increasing mortality within 30 days of pulmonary embolism, but no relationship between right ventricular function and the severity of embolic obstruction was found. It was concluded that: (1) the hemodynamic and right ventricular status may be very misleading as measures of the impact of pulmonary embolism in patients with pre-existing heart or lung disease; and (2) estimation of the role of pulmonary embolism in such patients must be based on a consideration of both the immediate pre-embolic cardiopulmonary status and the extent of embolic involvement.

Section snippets

MATERIALS AND METHODS

Hemodynamic measurements in this study were made at the time that PE was proved by selective pulmonary angiography in 36 consecutive, unselected patients. Only patients who showed intravascular filling defects or unequivocal vessel cutoffs by angiography were admitted to the study.4 All patients were men, ranging in age from 31 to 79 years (mean, 55.8) and all were studied in a stable, postabsorptive state. The population included 8 patients with normal cardiopulmonary status prior to embolism

RESULTS

Pulmonary embolic obstruction, estimated by angiography, ranged from 5 to 53 percent The greatest degrees of obstruction were observed in patients with no prior heart or lung disease (18 to 53 percent, mean 34.8 percent) and in patients with pre-embolic mitral valvular disease (22 to 50 percent, mean 31.5 percent). Lesser degrees were present among patients with AVD, CLD and CHD (Fig 1). Patients with aortic valvular disease, all of whom had previous CHF, had significantly less embolic

DISCUSSION

The consequences of varying degrees of pulmonary artery occlusion have been observed directly in the experimental animal for more than 80 years.5, 6, 7, 8 For most of this period, studies of the relationship between the magnitude of embolic obstruction and the cardiovascular response in man were impaired by the absence of a technique for defining the presence and extent of embolism during life. Shortly after selective pulmonary angiography was established as the definitive diagnostic tool,

REFERENCES (26)

  • MooreRL et al.

    Observations on resistance to the flow of blood to and from the lungs

    J Exp Med

    (1927)
  • GibbonJH et al.

    Changes in the circulation produced by gradual occlusion of the pulmonary artery

    J Clin Invest

    (1932)
  • McIntyreKM et al.

    Pulmonary thromboembolism: Current concepts

  • Cited by (112)

    • Perioperative risk and management in patients with pulmonary hypertension

      2013, Chest
      Citation Excerpt :

      Gradual increases in RV afterload are better tolerated than acute elevations.14 If severe and rapid enough, sudden increases in RV afterload due to an acute increase in PAP may precipitate RV failure and lower RV stroke volume.14,15 These increases can be related to hypercarbia, hypoxia, acidosis, and noxious stimuli such as pain and airway instrumentation.

    View all citing articles on Scopus

    Manuscript received January 22, 1973; revision accepted December 3.

    View full text