Joseph A Lodato1, R Parker Ward, Roberto M Lang. 1. University of Chicago Medical Center, 5841 S. Maryland Avenue, MC 5084, Chicago, IL 60637, USA. jlodato@medicine.bsd.uchicago.edu
Abstract
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.
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: Yu Lin Chen; Colin Wright; Anthony P Pietropaoli; Ayman Elbadawi; Joseph Delehanty; Bryan Barrus; Igor Gosev; David Trawick; Dhwani Patel; Scott J Cameron Journal: J Thromb Thrombolysis Date: 2020-01 Impact factor: 2.300