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      Association of Right Ventricular Dilatation with Bilateral Pulmonary Embolism, Pulmonary Embolism in a Main Pulmonary Artery and Lobar, Segmental and Subsegmental Pulmonary Embolism in 190 Patients with Acute Pulmonary Embolism


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          Background: Acute pulmonary embolism (PE) may result in right ventricular (RV) pressure overload with a dilated RV which can be diagnosed by two-dimensional echocardiography. Methods: A retrospective analysis was performed in 190 unselected patients who had acute PE documented by contrast-enhanced spiral computed tomographic scanning. The 190 patients included 104 women and 86 men, mean age 58 ± 15 years. Results: RV dilatation was present in 45 of 70 patients (64%) with bilateral PE, in 19 of 120 patients (16%) without bilateral PE, in 42 of 47 patients (89%) with main pulmonary artery embolism, in 34 of 84 patients (40%) with lobar PE, in 16 of 70 patients (23%) with segmental PE and in 6 of 36 patients (17%) with subsegmental PE; p < 0.001 comparing bilateral with no bilateral PE and main pulmonary artery embolism with no main pulmonary artery embolism, with lobar, segmental and subsegmental PE; p < 0.025 comparing lobar with segmental PE, and p < 0.02 comparing lobar with subsegmental PE. Conclusion: The prevalence of RV dilatation is highest in patients with main pulmonary artery embolism or bilateral pulmonary artery embolism; furthermore, the prevalence of RV dilatation is higher in patients with lobar PE than in patients with segmental or subsegmental PE.

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          Diagnostic utility of echocardiography in patients with suspected pulmonary embolism.

          The aim of this study was to investigate the clinical utility of echocardiography in the diagnosis of pulmonary embolism (PE). For this, we enrolled 162 patients with suspected PE in a prospective study. We evaluated the sensitivity and specificity of right ventricular dilatation, the Doppler evidence of pulmonary hypertension, and their possible associations. We also calculated the number of lung-scan angiography procedures avoided and the number of patients unnecessarily treated when echocardiography was included in the diagnostic work-up. The sensitivity and specificity of echocardiography ranged between 29 and 52% and between 96% and 87%, respectively. Adding echocardiography to the diagnostic strategy for PE would avoid about 12 to 28% of lung-scan angiography procedures, but would cause inappropriate treatment of 4 to 14% of all treated patients. The clinical utility of echocardiography in the diagnosis of PE is limited. The reduction in the number of standard diagnostic procedures obtained through its use would be counterbalanced by an excess of patients inappropriately treated.
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            Echocardiographic findings in patients with proved pulmonary embolism.

            Echocardiographic studies were performed in 105 patients with acute and recurrent pulmonary emboli. Pulmonary embolism was confirmed by pulmonary angiography (n = 48), autopsy (n = 6), and lung perfusion scintigraphy (n = 51). Seventy of 93 patients (75%) displayed a dilated right ventricle, 38 of 91 patients (42%) had reduced left ventricular cavity dimension, 41 of 82 patients (50%) had a decreased EF slope of the mitral valve, and 78 of 101 patients (77%) showed dilatation of the right pulmonary artery. The motion of the interventricular septum was abnormal in 41 of 93 patients (44%). Right-sided thrombi were seen in 13 patients within the right pulmonary artery (n = 11) and in the right ventricle (n = 3); in one patient they were found in the superior vena cava, in the innominate vein, and the right atrium. Two patients suffered from right-sided endocarditis. Thus echocardiographic changes were frequently found in patients with proved pulmonary emboli. The echocardiographic findings of right-sided cardiac and pulmonary artery abnormalities indicate hemodynamically active pulmonary emboli.

              Author and article information

              S. Karger AG
              April 2005
              07 April 2005
              : 103
              : 3
              : 156-157
              Department of Medicine, Cardiology Division, Westchester Medical Center/New York Medical College, Valhalla, N.Y., USA
              84585 Cardiology 2005;103:156–157
              © 2005 S. Karger AG, Basel

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              Page count
              Tables: 1, References: 5, Pages: 2
              General Cardiology


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