Elevated D-Dimers and Right Ventricular Dysfunction on Echocardiography for Diagnosis of Pulmonary Embolism: A Validation Study

Abstract

Background There is an increasing need to explore other non-invasive techniques for the diagnosis of pulmonary embolism in resource-limited countries. Objective To assess the validity of elevated D-dimer levels and right ventricular (RV) dysfunction on echocardiography in predicting definite massive pulmonary embolism among patients diagnosed with massive pulmonary embolism using computed tomography (CT) pulmonary angiography as the gold standard. Methods The patients with acute massive pulmonary embolism on CT pulmonary angiography were included. The participants underwent 12-lead electrocardiography, assessment of D-dimer levels, and bedside echocardiography to determine right ventricular dysfunction. The data were recorded on a proforma and analyzed using IBM SPSS software version 26.0 (IBM Corp., Armonk, NY). Results There were 160 patients in the study. The mean age was 49.19 ± 14.89 years. Elevated D-dimer levels were seen in 80.60% of the patients whereas ventricular dysfunction on echocardiography was seen in 90.00% of the patients. The sensitivity and specificity of elevated D dimer levels were 78.99% and 14.60%, respectively. The positive predictive values (PPV) and negative predictive values (NPV) for elevated D-dimer levels were 72.87% and 19.35%, respectively. In contrast, the sensitivity of ventricular dysfunction was 94.96% and specificity 24.39%. PPV was found to be 78.47% and NPV was 62.50%. Conclusion Positive D-dimer levels and ventricular dysfunction on echocardiography are sensitive enough to consider the diagnosis of massive pulmonary embolism but lack adequate specificity, thus, necessitating the presence of other noninvasive tests.

Bedside critical ultrasound as a key to the diagnosis of obstructive atelectasis complicated with acute cor pulmonale and differentiation from pulmonary embolism: A case report

“…PE cannot be detected by lung ultrasound because embolism in the arterioles and capillaries of the lungs is hardly detected by ultrasound. 11 The diagnostic procedures of PE in the BLUE protocol were as follows: (1) normal pleural sliding, (2) a profile of both lungs, and…”

“…Most lung areas showed A‐lines, and thrombosis was found in the veins of both lower limbs, which seemed to be more consistent with the diagnosis of PE. PE cannot be detected by lung ultrasound because embolism in the arterioles and capillaries of the lungs is hardly detected by ultrasound 11 . The diagnostic procedures of PE in the BLUE protocol were as follows: (1) normal pleural sliding, (2) a profile of both lungs, and (3) thrombosis in DVT 5 .…”