BACKGROUND: A normally contracting right ventricular apex associated to a severe hypokinesia of the mid-free wall ('McConnell sign') has been considered a distinct echocardiographic pattern of acute pulmonary embolism. OBJECTIVE: To evaluate the clinical utility of the 'McConnell sign' in the bedside diagnostic work-up of patients presenting to the Emergency Department with an acute right ventricular dysfunction due to pulmonary embolism or right ventricular infarction. DESIGN: Among 201 patients, consecutively selected from our clinical database and diagnosed as having massive or submassive pulmonary embolism or right ventricular infarction, 161 were suitable for an echocardiographic review of regional right ventricular contraction and were included in the study. There were 107 cases with pulmonary embolism (group 1) and 54 cases with right ventricular infarction (group 2). All echocardiographic studies were randomly examined by two experienced and independent echocardiographers, blinded to the patient diagnosis and without Doppler informations. RESULTS: The McConnell sign was detected in 75 of 107 patients in group 1 (70%) and in 36 of 54 patients in group 2 (67%); the finding was absent in 32 cases in group 1 and in 18 cases in group 2 (P=0.657). The sensitivity, specificity, positive and negative predictive values of the McConnell sign for the diagnosis of pulmonary embolism were respectively 70, 33, 67 and 36%. CONCLUSIONS: In a clinical setting of patients with acute right ventricular dysfunction the McConnell sign cannot be considered a specific marker of pulmonary embolism.
BACKGROUND: A normally contracting right ventricular apex associated to a severe hypokinesia of the mid-free wall ('McConnell sign') has been considered a distinct echocardiographic pattern of acute pulmonary embolism. OBJECTIVE: To evaluate the clinical utility of the 'McConnell sign' in the bedside diagnostic work-up of patients presenting to the Emergency Department with an acute right ventricular dysfunction due to pulmonary embolism or right ventricular infarction. DESIGN: Among 201 patients, consecutively selected from our clinical database and diagnosed as having massive or submassive pulmonary embolism or right ventricular infarction, 161 were suitable for an echocardiographic review of regional right ventricular contraction and were included in the study. There were 107 cases with pulmonary embolism (group 1) and 54 cases with right ventricular infarction (group 2). All echocardiographic studies were randomly examined by two experienced and independent echocardiographers, blinded to the patient diagnosis and without Doppler informations. RESULTS: The McConnell sign was detected in 75 of 107 patients in group 1 (70%) and in 36 of 54 patients in group 2 (67%); the finding was absent in 32 cases in group 1 and in 18 cases in group 2 (P=0.657). The sensitivity, specificity, positive and negative predictive values of the McConnell sign for the diagnosis of pulmonary embolism were respectively 70, 33, 67 and 36%. CONCLUSIONS: In a clinical setting of patients with acute right ventricular dysfunction the McConnell sign cannot be considered a specific marker of pulmonary embolism.
Authors: A Malagoli; A Albini; G E Mandoli; A Baggiano; G Vinco; F Bandera; A D'Andrea; R Esposito; F D'Ascenzi; R Sorrentino; C Santoro; G Benfari; F Contorni; M Cameli Journal: Int J Cardiovasc Imaging Date: 2021-06-10 Impact factor: 2.357
Authors: Ana Cristina Lopes Albricker; Cláudia Maria Vilas Freire; Simone Nascimento Dos Santos; Monica Luiza de Alcantara; Mohamed Hassan Saleh; Armando Luis Cantisano; José Aldo Ribeiro Teodoro; Carmen Lucia Lascasas Porto; Salomon Israel do Amaral; Orlando Carlos Gloria Veloso; Ana Cláudia Gomes Pereira Petisco; Fanilda Souto Barros; Márcio Vinícius Lins de Barros; Adriano José de Souza; Marcone Lima Sobreira; Robson Barbosa de Miranda; Domingos de Moraes; Carlos Gustavo Yuji Verrastro; Alexandre Dias Mançano; Ronaldo de Souza Leão Lima; Valdair Francisco Muglia; Cristina Sebastião Matushita; Rafael Willain Lopes; Artur Martins Novaes Coutinho; Diego Bromfman Pianta; Alair Augusto Sarmet Moreira Damas Dos Santos; Bruno de Lima Naves; Marcelo Luiz Campos Vieira; Carlos Eduardo Rochitte Journal: Arq Bras Cardiol Date: 2022-04 Impact factor: 2.000