Prognostic Value of Echocardiographic Right/Left Ventricular End-Diastolic Diameter Ratio in Patients With Acute Pulmonary Embolism

Fremont, B.; Pacouret, G; Jacobi, David; Puglisi, Raphaël; Charbonnier, B; Labriolle, Axel de

doi:10.1378/chest.07-1231

Cited by 221 publications

(147 citation statements)

References 17 publications

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“…We derived CLUE to quickly screen for important targets that had evidence-basis to affect outcome, such as manifestations of subclinical atherosclerosis or chamber enlargement due to elevated filling pressures. Subsequent CLUE outcome studies have demonstrated diagnostic accuracy and prognostic value in its components, 18,26,29,30 and an effect upon medical decisionmaking, 21 even when performed by briefly trained novices. 18,21,30 It is anticipated that this cardiovascular examination will later expand to a more advanced version or become a component of a full-body ''ultrasoundassisted physical.''…”

Section: Discussionmentioning

confidence: 99%

“…Evidence-basis for the exam targets and specifics of subjective diagnostic CLUE criteria (Table 1) have been published elsewhere. [21][22][23][24][25][26][27][28][29][30] Two useful mnemonics were created to teach the imaging protocol. If using only the 3 MHz cardiac probe, residents were taught to ''work backward'' against the flow of blood, in regards to physiologic effects and the sequence of CLUE views.…”

Section: Program Overviewmentioning

confidence: 99%

“…A large effusion and dilated IVC are mandatory in the consideration of tamponade by the resident 7. RV enlargement Size (AP diameter) of the RV appears equal or greater than the LV 29 .…”

Section: Lung Comet-tail Artifactmentioning

confidence: 99%

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Observations during development of an internal medicine residency training program in cardiovascular limited ultrasound examination

Kimura

Amundson

Phan

et al. 2012

Journal of Hospital Medicine

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BACKGROUND: Despite the future potential of using ultrasound stethoscopes to augment the bedside cardiac physical, few data exist on a general cardiovascular imaging protocol that can be taught to physicians on a perpetual basis as a curriculum in graduate medical education. METHODS: During the past decade, we developed and integrated a cardiovascular limited ultrasound training program within the confines of an internal medicine residency. The evidence‐based rationale for the exam, the teaching methods, and curriculum are delineated, and subsequent observations regarding program requirements, proficiency, and academic outcomes are explored. Analysis of variance and linear regression assessed for relationships between academic scores, chief resident selection, and gender to proficiency in ultrasound. RESULTS: A brief, 5‐minute cardiovascular limited ultrasound exam (CLUE) was taught using both didactic and bedside methods, and practiced primarily within the cardiology consult, outpatient clinic, and intensive care rotations. Program costs were minimized by employing readily available institutional resources. After a 2‐year lead‐in training phase, the subsequent 4 years of senior resident performance (n = 41 residents) showed an 81% pass rate in CLUE competency. Resident ultrasound performance did not relate to academic scores (r = 0.05, P = 0.75), chief resident selection, nor gender. Observations regarding resident pitfalls in CLUE practice and increased participation in extracurricular research are described. CONCLUSIONS: We report our initial experience in developing and implementing a training program for bedside cardiovascular ultrasound examination that employed evidence‐based techniques, set proficiency goals, and assessed resident performance. It may be feasible to teach future internist–hospitalists the technique of bedside ultrasound during residency. Journal of Hospital Medicine 2012;. © 2012 Society of Hospital Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Program Overviewmentioning

confidence: 99%

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Observations during development of an internal medicine residency training program in cardiovascular limited ultrasound examination

Kimura

Amundson

Phan

et al. 2012

Journal of Hospital Medicine

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“…Its diagnostic ability is also operator and patient dependent [3]. Previous echocardiographic studies in PE patients mostly concentrated on the right and left ventricular measurements [21,23,24]. We are aware of only one echocardiography work that demonstrated that an increased ratio of right to left atrial end-systolic area correlated with obstruction of more than 30% of the pulmonary arterial tree [25].…”

Section: Discussionmentioning

confidence: 99%

The association between the embolic load and atrial size in acute pulmonary embolism

Aviram

Steinvil

Berliner

et al. 2011

Journal of Thrombosis and Haemostasis

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Summary. Background: Early identification by computed tomography pulmonary angiography (CTPA) of patients with acute pulmonary embolism (PE) who have signs associated with a high embolic burden would be highly desirable. Objectives: To investigate whether an increased obstruction of the pulmonary vasculature is associated with reduced left atrial (LA) and increased right atrial (RA) areas. Methods: We retrospectively analyzed a consecutive series of CTPA studies of 137 patients with acute PE and 38 controls without PE between October 2004 and March 2006. Left and right atrial areas and longitudinal and short axis diameters were measured and correlated with the pulmonary arterial obstruction index (PAOI) divided into tertiles (obstruction of < 12.5%, 12.5%-42.5% and ‡ 42.5%). Results: There was a significant negative age-and gender-adjusted correlation between the PAOI and LA measurements, particularly the LA area (r = )0.259) and the LA short axis diameter (r = )0.331). All RA measurements had positive correlations (RA area, r = 0.279; RA short axis diameter, r = 0.313). The LA/RA area ratio correlated negatively with the PAOI (r = )0.447). All above-mentioned correlations had P < 0.002. All the LA measurements were the largest in the controls and gradually decreased with higher PAOIs. A receiver operating characteristic curve analysis demonstrated that the RV/LV diameter, LA/RA area and LA/RA short axis diameter ratios had comparable discriminative ability for higher PAOI tertiles. Conclusions: The higher the clot load in the pulmonary arteries, the smaller the LA area and the larger the RA area. Atrial area measurements by CTPA may serve as a real-time parameter in assessing the severity of PE upon diagnosis.

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“…25,43,44 Acute RV failure is the main cause of death in acute PE, and RV dysfunction on echocardiography is associated with high mortality. 45 A recent meta-analysis has also confirmed this association. 46 Brain natriuretic peptides (BNPs) and N-terminal proBNP (NT-proBNP) are specific markers of stress on ventricular wall.…”

Section: Risk Assessment and Stratificationmentioning

confidence: 79%

Diagnosis and Management of Acute Pulmonary Embolism

Dokwal¹

2014

PULSE

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Prognostic Value of Echocardiographic Right/Left Ventricular End-Diastolic Diameter Ratio in Patients With Acute Pulmonary Embolism

Cited by 221 publications

References 17 publications

Observations during development of an internal medicine residency training program in cardiovascular limited ultrasound examination

Observations during development of an internal medicine residency training program in cardiovascular limited ultrasound examination

The association between the embolic load and atrial size in acute pulmonary embolism

Diagnosis and Management of Acute Pulmonary Embolism

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