PROGNOSTIC-SIGNIFICANCE OF RIGHT-VENTRICULAR HYPOKINESIS AND PERFUSION LUNG-SCAN DEFECTS IN PULMONARY-EMBOLISM

We studied the relation between right ventricular (RV) hypokinesis on echocardiography and defects on the initial perfusion lung scan among 90 hemodynamically stable patients with pulmonary embolism (PE). Of th e 90, 38 had qualitative evidence of RV hypokinesis, with a mean RV en d-diastolic area significantly larger than those with normal RV wall m otion (40.0 +/- 10.2 cm(2) vs 20.1 +/- 6.4 cm(2); p < 0.001). The degr ee of the perfusion defect was greater in those patients with baseline RV hypokinesis (54% +/- 16% of the lung nonperfused) than in those pa tients with normal RV wall motion at baseline (30% +/- 18% nonperfused lung; p < 0.001). Receiver operating characteristic curve analysis sh owed that a perfusion lung scan defect score of 0.3 (i.e., 30% of the lung nonperfused) had a 92% sensitivity for predicting RV hypokinesis and carried a relative risk for observing RV hypokinesis of 6.8 times greater than among those patients with a perfusion scan score of <0.3. Considering that all patients with recurrent symptomatic PE were in t he subgroup with RV hypokinesis (13% vs 0% for those with normal RV wa ll motion; p = 0.01), a strategy of performing echocardiography in tho se patients with a perfusion scan defect score of greater than or equa l to 0.3 appears to identify patients at increased risk for recurrent PE.