Document Detail


Echocardiographic predictors of pulmonary embolism in patients referred for helical CT.
MedLine Citation:
PMID:  18652005     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Transthoracic echocardiography (TTE) is ordered frequently in patients with suspected pulmonary embolism (PE). Multiple indices have been suggested to play a useful diagnostic role. We sought to determine the relative predictive accuracy of suggested quantitative indices among patients referred for CT scanning for exclusion of PE. METHODS: We retrospectively identified 67 consecutive patients who underwent CT for the exclusion of PE, and had a TTE within 48 hours of CT. Echo indices suggested to play a role in the diagnosis of PE were measured RV/LV area ratio, RV/LV end diastolic dimension ratio, the "McConnell" sign, interventricular septal shift ("D-sign"), Pulmonary artery diameter, tricuspid regurgitation velocity, and "60/60 sign" (TR velocity < 3.9 m/sec plus pulmonary artery acceleration time < 60 msec). RESULTS: CT confirmed PE in 41 (61%). Mean age was 58 (18-92). Forty-five were female. Subjects with PE were younger, and more likely to be tachycardic and require ICU admission. Of the echocardiographic indices, RV/LV EDD ratio > 0.7 was the most accurate predictor (sensitivity 66%, specificity 77%). The McConnell sign was the most specific (96%), however, with poor sensitivity (16%). Mean TR velocities did not differ between those with and without PE (270 +/- 74 vs. 294 +/- 83, P = 0.25). CONCLUSIONS: RV/LV EDD ratio > 0.7 has good accuracy for the diagnosis of acute PE. RV/LV area ratio > 0.7 and McConnell sign are specific but not sensitive indicators of acute pulmonary embolism. The presence of these findings should prompt further diagnostic testing for PE.
Authors:
Joseph A Lodato; R Parker Ward; Roberto M Lang
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  Echocardiography (Mount Kisco, N.Y.)     Volume:  25     ISSN:  1540-8175     ISO Abbreviation:  Echocardiography     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-07-23     Completed Date:  2008-09-23     Revised Date:  2009-02-02    
Medline Journal Info:
Nlm Unique ID:  8511187     Medline TA:  Echocardiography     Country:  United States    
Other Details:
Languages:  eng     Pagination:  584-90     Citation Subset:  IM    
Affiliation:
University of Chicago Medical Center, 5841 S. Maryland Avenue, MC 5084, Chicago, IL 60637, USA. jlodato@medicine.bsd.uchicago.edu
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MeSH Terms
Descriptor/Qualifier:
Echocardiography / methods*
Female
Humans
Male
Middle Aged
Prognosis
Pulmonary Embolism / radiography*,  ultrasonography*
Reproducibility of Results
Risk Assessment / methods*
Risk Factors
Sensitivity and Specificity
Tomography, Spiral Computed / methods*
Comments/Corrections
Erratum In:
Echocardiography. 2008 Oct;25(9):ii

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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