Diagnostic Accuracy of Early Systolic Notching in Pulmonary Embolism

Abstract

Objective Recently, a cardiac sonography finding, early systolic notching (ESN), was reported with high sensitivity and specificity for the diagnosis of pulmonary embolism (PE) in a limited population. The aim of this study was to determine the diagnostic accuracy of ESN finding for PE in emergency department (ED) patients. Method This prospective multicenter study was conducted in 4 academic EDs. All patients who underwent computed tomography angiography for suspected PE were included in the study. After inclusion, cardiac ultrasound including the right ventricular outflow tract Doppler signal was performed. The diagnostic tests of ESN finding were used for PE and its subgroups. Results In the study, 183 of 201 patients met the study criteria. Of all patients, 52.5% had PE (n = 96), and 19.7% (n = 36) had ESN finding. In all ED patients, the sensitivity of ESN for PE was 34% (95% CI 25–45), and the specificity was 97% (95% CI 90–99). In the subgroup analysis, the sensitivity of ESN for PE with high or intermediate‐high risk was 69% (95% CI 49–85), and the specificity was 90% (95% CI 84–94). Inter‐rater reliability for ESN finding between the cardiologist and emergency physician was strong with a kappa statistic of 0.87. Conclusion The pulmonary Doppler flow of ESN was moderate to high specific but low sensitive for PE in all ED patients. In the subgroup analysis, this finding was moderate specific and low sensitive.

Comparison of echocardiographic pulmonary flow Doppler markers in patients with massive or submassive acute pulmonary embolism and control group: A cross‐sectional study

“…In the analysis of subgroups with intermediate to high risk of PE disease, 69% sensitivity and 90% specificity was observed for the ESN pattern. They supported that ESN has low sensitivity and moderate to high specificity for detecting PE in all patients referred to the emergency department 23 …”

“…They supported that ESN has low sensitivity and moderate to high specificity for detecting PE in all patients referred to the emergency department. 23 …”

Pocus No Manejo De Tromboembolismo Pulmonar

“…Alerhand et al (2021), trouxe em seu estudo os relatos da literatura que a ESN apresenta uma sensibilidade de 92% e especificidade de 99% para os eventos maciços e submaciços, com contraponto para os eventos subsegmentares, com apenas 2% de sensibilidade (ALERHAND et al, 2021). Aslaner et al (2022), avaliou a sensibilidade e especificidade desse achado e entra em discordância com o estudo de Alerhand et al (2021), apresentando uma baixa sensibilidade para ESN mesmo em TEP com grau de severidade intermediário ou elevado, com um total de 69%. Po-rém, o autor relata limitações durante o experimento e destaca o impedimento pela pandemia do Sars-CoV-2 e a limitação de amostra, o que pode ter causado um viés de seleção.…”

“…Po-rém, o autor relata limitações durante o experimento e destaca o impedimento pela pandemia do Sars-CoV-2 e a limitação de amostra, o que pode ter causado um viés de seleção. No final do experimento é demonstrado um bom intervalo de confiança entre os médicos cardiologistas e os emergências que fizeram o uso da ultrassonografia, sendo um bom parâmetro de avaliação, porém, ainda não há estudos suficientes que sustente o uso desse achado isoladamente, sendo necessário associação com outras apresentações clínicas (ASLANER et al, 2022).…”

“…Sobre a acurácia desse método, mesmo para aqueles médicos com pouca formação na técnica do POCUS, apresentaram uma sensibilidade e especificidade de 96% e 97% respectivamente, havendo ganhos diante a acurácia do examinador, alcançando até 100% de especificidade (ALBRICKER et al, 2022;ARNOLD & JONAS, 2020;BARROSSE-ANTLE et al, 2021;FISCHER et al, 2019;LIEVELD et al, 2022).…”