Regression of right ventricular hypokinesis after thrombolysis in acute pulmonary embolism

Stein et al(1) recently demonstrated increased morbidity associated with thrombolysis when pulmonary embolism is managed invasively. Echocardiographic right ventricular dysfunction due to pulmonary embolism and its quick reversal after fibrinolytic therapy have been reported.(2) A sudden increase in pulmonary pressure may cause right ventricular dilation and right ventricular hypokinesia, possibly resulting in acute right ventricular failure. An echocardiographic automated boundary detection (ABD) system, based on ultrasonic backscatter imaging, has been developed and allows on-line endocardial wall detection and assessment of beat-to-beat cardiac chamber dimensions and function.(3) Despite the irregular shape of the right ventricle, the capability and reproducibility of this method to assess right Ventricular areas and fractional area changes have been shown.(4) We sought to prospectively relate the early changes in right ventricular function using acoustic quantification with angiographic improvement after thrombolysis in acute pulmonary embolism.