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[The early echocardiographic diagnosis of a massive pulmonary embolism]
F Casazza1, F Centonze, M Chirico
1Divisione di Cardiologia, Ospedale S. Carlo Borromeo, Milano.
Background:
In several cases of clinically suspected massive pulmonary embolism (MPE), a lung perfusion scanning and/or a pulmonary angiography are not quickly available or feasible.
Methods:
Fifty patients admitted to our ICU with a clinically suspected MPE underwent an echocardiographic (Echo) investigation very shortly after onset (within 2 hours in 38 cases, and within 6 hours in 12). An Echo-Doppler study was also performed in 18 patients.
Results:
Highly significant differences (p < 0.001) emerged between patients with PE and healthy age-mates for each type of Echo measurement and in all views. The RVDD/LVDD ratio turned out to be the most frequently affected parameter, being altered in 96% of cases. An abnormal diastolic leftward shift of the interventricular septum was detected in 81% of cases. Only one of our 50 patients failed to show any evidence of RV pressure overload; however, this was a patient with a severe dilated cardiomyopathy. In 22 cases in whom hemodynamic monitoring was performed, no significant correlation emerged between RVDD and LVDD, on one hand, mean PAP and cardiac index on the other. All 18 patients examined by Echo-Doppler had mild to moderate tricuspid regurgitation with a peak RV-RA gradient of 38 +/- 7 mm Hg (range 31-53 mm Hg). Seven patients (14%) were found to harbor right heart thrombi when first examined. Overall mortality in this uncommonly high risk population was as high as 28%.
Conclusions:
In a clinical setting suggesting a MPE, an Echo study conducted very shortly after onset may corroborate a tentative diagnosis of PE, thereby permitting timely fibrinolytic therapy pending a lung scan and/or angiography, or in situations where such imaging facilities are not available or readily usable.
Insights
Echocardiography can quickly support massive pulmonary embolism (MPE) diagnosis when lung scans are unavailable. This rapid Echo assessment aids timely treatment for suspected MPE patients.
Area of Science:
- Cardiology
- Radiology
- Critical Care Medicine
Background:
- Massive pulmonary embolism (MPE) diagnosis can be delayed when standard imaging is unavailable.
- Rapid diagnostic tools are crucial for suspected MPE cases.
Purpose of the Study:
- To evaluate the utility of early echocardiography in diagnosing MPE.
- To assess echocardiographic parameters indicative of right heart strain in MPE.
Main Methods:
- Fifty ICU patients with suspected MPE underwent rapid echocardiography (within 6 hours).
- Echocardiography-Doppler was performed in 18 patients.
- Key parameters included RV/LV dimensions and interventricular septum shift.
Main Results:
- Significant echocardiographic differences were found between MPE patients and controls (p < 0.001).
- Right ventricular diastolic diameter/left ventricular diastolic diameter (RVDD/LVDD) ratio was abnormal in 96% of cases.
- Right heart thrombi were found in 14% of patients, with 28% overall mortality.
Conclusions:
- Early echocardiography can rapidly corroborate MPE diagnosis.
- This facilitates timely fibrinolytic therapy when lung scans are not feasible or available.
- Echocardiography provides crucial information for managing suspected MPE.