Differentiation between acute and chronic cor pulmonales with midventricular systolic strain of the right ventricle in the emergency department

Cor pulmonale (CP) is defined as the structural and functional alternation of the right ventricle (RV) caused by primary disorders of the respiratory system. We aimed to differentiate acute CP complicated with massive pulmonary thromboembolism (PTE) from the chronic form due to severe chronic obstructive pulmonary disease (COPD) with strain analysis of RV in the emergency department. We included patients showing echocardiographic features of pulmonary hypertension in the emergency department. From March 2005 to July 2006, a total of 52 patients, 24 consecutive patients with acute CP (ten males, mean 69 ± 10 years) and 28 consecutive patients with chronic CP associated with severe COPD (22 males, mean 63 ± 14 years), were included. Echocardiographic data and strain analyses were obtained with GE Vivid 7. There was no statistical difference in age, fractional area change of RV, TR Vmax, and Tei index in both groups. However, more males were included in the chronic group. Midventricular systolic strain of RV was significantly increased in patients with acute CP. Regarding the midventricular systolic strain in the detection of acute CP by the receiver operating curve analysis, the best sensitivity and specificity were obtained when −12.2% was applied as the criterion (more than −12.2% for predicting an acute CP, the sensitivity, specificity, and accuracy were 83.3, 78.6, and 80.8%, respectively). Midventricular systolic strain of RV can be used in the differentiation between acute and chronic CPs in the emergency department.