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(Chest. 1974;65:534-543.)
© 1974 American College of Chest Physicians

Determinants of Right Ventricular Function and Hemodynamics after Pulmonary Embolism

Kevin M. McIntyre M.D.1 and Arthur A. Sasahara M.D.2

1 Assistant Chief, Cardiology Section, Veterans Administration Hospital, West Roxbury; Assistant Professor of Medicine, Harvard Medical School
2 Chief, Cardiopulmonary Section, Veterans Administration Hospital, West Roxbury; Associate Professor of Medicine, Harvard Medical School

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 close 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 lung 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 preembolic cardiopulmonary status and the extant of embolic involvement.

Submitted on January 22, 1973
Accepted on December 3, 1974




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