Echocardiographic findings in patients with proved pulmonary embolism

Kasper, Wolfgang; Meinertz, Thomas; Henkel, Bernd; Eißner, D; Hahn, Klaus; Hofmann, Thomas; Zeiher, Andreas M.; Just, Hanjörg

doi:10.1016/0002-8703(86)90361-3

Cited by 184 publications

(82 citation statements)

References 29 publications

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“…Thus, the ECG abnormalities that were reported in earlier studies [15,35] to indicate severe PE also appeared to affect prognosis in the present study, although the current authors could not confirm the prognostic relevance of the anterior subepicardial ischaemic pattern indicated by T-wave inversion over leads V1-V4 [16]. In addition, there appeared to be a tendency towards a correlation between a pathological ECG (defined as at least one of the above abnormalities) and the echocardiographic detection of right ventricular dilatation, a reliable marker of overt or impending right ventricular failure and an established predictor of in-hospital outcome [5,31]. When examined by multivariate analysis, none of the ECG abnormalities was individually associated with a poor outcome after adjustment for the patients' clinical symptoms and findings on admission, and for the presence of pre-existing pulmonary and cardiac disease.…”

Section: Discussionmentioning

confidence: 73%

“…At present, more than 30 yrs after the experimental studies of MCINTYRE and SASAHARA [29,30] on the haemodynamic response to pulmonary vascular obstruction, right ventricular dysfunction and failure is widely accepted to be the single most important determinant of outcome in the acute phase of venous thromboembolism. Accordingly, the prognostic value of echocardiographic and, more recently, CT imaging in patients with suspected PE lies primarily in the detection of right ventricular dilatation and/or hypokinesis [10,13,31,32]. However, it has never been directly tested in a large patient population whether risk assessment based on acute right heart strain might also be possible using a simple baseline test, such as the 12-lead ECG.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic value of the ECG on admission in patients with acute major pulmonary embolism

Geibel

Zehender²,

Kasper³

et al. 2005

European Respiratory Journal

182

109

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A number of ECG abnormalities can be observed in the acute phase of pulmonary embolism (PE). Their prognostic value has not yet been systematically studied in large patient populations.In 508 patients with acute major PE derived from a large prospective registry, the current authors assessed, on admission, the impact of specific pathological ECG findings on early (30-day) mortality.Atrial arrhythmias, complete right bundle branch block, peripheral low voltage, pseudoinfarction pattern (Q waves) in leads III and aVF, and ST segment changes (elevation or depression) over the left precordial leads, were all significantly more frequent in patients with a fatal outcome. Overall, 29% of the patients who exhibited at least one of these abnormalities on admission did not survive to hospital discharge, as opposed to only 11% of the patients without a pathological 12-lead ECG. Multivariate analysis revealed that the presence of at least one of the above ECG findings was, besides haemodynamic instability, syncope and pre-existing chronic pulmonary disease, a significant independent predictor of outcome.In conclusion, ECG may be a useful, simple, non-costly tool for initial risk stratification of patients with acute major pulmonary embolism.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Prognostic value of the ECG on admission in patients with acute major pulmonary embolism

Geibel

Zehender²,

Kasper³

et al. 2005

European Respiratory Journal

182

109

View full text Add to dashboard Cite

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“…The presence of pulmonary hypertension had to be confirmed by at least one of the following findings: (1) dilation of the right pulmonary artery, defined as cross-sectional diameter Ͼ12 mm/m 2 body surface area on the suprasternal echocardiogram, 11 (2) tricuspid regurgitant jet velocity of Ͼ2.5 m/s on Doppler echocardiography in the absence of inspiratory collapse of the inferior vena cava, 10 or (3) diagnosis of precapillary pulmonary hypertension on catheterization of the right side of the heart (systolic pulmonary arterial pressure Ն35 mm Hg or mean pressure Ն20 mm Hg in the presence of normal pulmonary artery occlusion pressure).…”

Section: Study Populationmentioning

confidence: 99%

Patent Foramen Ovale Is an Important Predictor of Adverse Outcome in Patients With Major Pulmonary Embolism

et al. 1998

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Background-Right-to-left shunt through a patent foramen ovale is frequently diagnosed by contrast echocardiography and can be particularly prominent in the presence of elevated pressures in the right side of the heart. Its prognostic significance in patients with pulmonary thromboembolism, however, is unknown. Methods and Results-The present prospective study included 139 consecutive patients with major pulmonary embolism diagnosed on the basis of clinical, echocardiographic, and cardiac catheterization criteria. All patients underwent contrast echocardiography at presentation. The end points of the study were overall mortality and complicated clinical course during the hospital stay defined as death, cerebral or peripheral arterial thromboembolism, major bleeding, or need for endotracheal intubation or cardiopulmonary resuscitation. Patent foramen ovale was diagnosed in 48 patients (35%). These patients had a death rate of 33% as opposed to 14% in patients with a negative echo-contrast examination (Pϭ.015). Logistic regression analysis demonstrated that the only independent predictors of mortality in the study population were a patent foramen ovale (odds ratio

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“…Echocardiography was not performed routinely in the authors' institution at the time of the trial. Consequently, echocardiographic signs of right ventricular dysfunction [24,25] were not available for analysis. Thus, their ability to predict the cardiorespiratory efficacy of TT could not be evaluated in the present study.…”

Section: Discussionmentioning

confidence: 99%

Cardiorespiratory efficacy of thrombolytic therapy in acute massive pulmonary embolism: identification of predictive factors

Michard

Meyer²,

Wysocki³

et al. 1999

Eur Respir J

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The aim of this study was to evaluate the contribution of clinical, angiographic and haemodynamic findings in predicting the cardiorespiratory efficacy of thrombolytic therapy in acute massive pulmonary embolism.Haemodynamic measurements and pulmonary angiography were performed before (H 0 ) and 12 h after (H 12 ) initiating thrombolytic therapy in 23 patients with acute massive pulmonary embolism (Miller index $20/34), and free of prior cardiopulmonary disease. Patients were divided into two groups according to the variation in oxygen delivery (DDO 2 ) between H 0 and H 12 : DDO 2 >20% (responders, n=10) and DDO 2 #20% (nonresponders, n=13).Before thrombolysis, clinical and angiographic findings were similar in both groups. Mean right atrial pressure (RAP) and total pulmonary (vascular) resistance (TPR) were higher, while cardiac index (CI), DO 2 and mixed venous oxygen saturation (Sv,O 2 ) were lower in responders. DO 2 and Sv,O 2 were more closely correlated with DDO 2 than RAP, TPR and CI. Eight out of the 10 responders and two out of the 13 nonresponders had an Sv,O 2 <55%, while nine of the responders and two of the nonresponders had a DO 2 <350 mL . min -1 . m -2 . In conclusion, the initial oxygen delivery and mixed venous oxygen saturation may predict the cardiorespiratory efficacy of thrombolytic therapy in acute massive pulmonary embolism. When pulmonary angiography is performed, measurement of mixed venous oxygen saturation may be a simple method by which to select patients for thrombolytic therapy. Eur Respir J 1999; 13: 610±615. Thrombolytic therapy (TT) is frequently used in acute massive pulmonary embolism (AMPE) because it induces a faster decrease in pulmonary vascular obstruction and a faster haemodynamic improvement than heparin alone [1,2]. Although TT should be life-saving in patients with AMPE and hypotension [3], its benefit in patients without clinical shock remains to be proved. Moreover, TT does not achieve significant haemodynamic improvement in 11±55% of the patients [4] and its use is associated with a 14% incidence of major bleeding complications [5]. Consequently, careful selection of patients with AMPE is advocated before initiation of TT. However, predictive factors of the efficacy of TT are lacking.The aim of the present study was to assess the effect of TT on oxygen delivery (DO 2 ) and to identify predictive factors of this cardiorespiratory effect in normotensive patients with AMPE and free of prior cardiopulmonary disease. The improvement in DO 2 was selected to assess the cardiorespiratory efficacy of TT since AMPE induces arterial hypoxaemia [6] and right ventricular failure [1,7,8], both resulting in a decrease in DO 2 . Materials and methodsAs part of a multicentre double-blind trial approved by the European Ethical Review Committee comparing the effects of urokinase and alteplase in 63 patients with AMPE [9], the 34 patients recruited in the authors' centre were considered for the present study.Patients were eligible if they met the following inclusion criter...

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Echocardiographic findings in patients with proved pulmonary embolism

Cited by 184 publications

References 29 publications

Prognostic value of the ECG on admission in patients with acute major pulmonary embolism

Prognostic value of the ECG on admission in patients with acute major pulmonary embolism

Patent Foramen Ovale Is an Important Predictor of Adverse Outcome in Patients With Major Pulmonary Embolism

Cardiorespiratory efficacy of thrombolytic therapy in acute massive pulmonary embolism: identification of predictive factors

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