Role of Cardiac Ultrasound in the Detection of Pulmonary Embolism

Konstantinides, Stavros; Geibel, Annette; Kasper, Wolfgang

doi:10.1055/s-2007-1009871

Cited by 13 publications

(8 citation statements)

References 94 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The abrupt or progressive increase in afterload leads in turn to enlargement and dysfunction (hypokinesis) of the right ventricle. It has been demonstrated that the presence of right ventricular dilation, which can be rapidly and reliably diagnosed by bedside echocardiography [14,15,34], is associated with increased in-hospital mortality in patients presenting with clinically suspected PE [35]. These findings are in accordance with current theories which emphasize that death due to acute PE is death resulting from right heart failure [36].…”

Section: The Bleeding Risk Associated With Thrombolytic Treatmentsupporting

confidence: 67%

The case for thrombolysis in acute major pulmonary embolism: hemodynamic benefits and beyond

Konstantinides

2002

Intensive Care Medicine

Self Cite

View full text Add to dashboard Cite

Section: The Bleeding Risk Associated With Thrombolytic Treatmentsupporting

confidence: 67%

The case for thrombolysis in acute major pulmonary embolism: hemodynamic benefits and beyond

Konstantinides

2002

Intensive Care Medicine

Self Cite

View full text Add to dashboard Cite

“…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%

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

Geibel

Zehender²,

Kasper³

et al. 2005

European Respiratory Journal

191

109

View full text Add to dashboard Cite

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.

show abstract

“…It has been demonstrated that the presence of right enrolled were randomly assigned to receive alteplase (100mg over ventricular dilation, which can be rapidly and reliably diagnosed 2 hours) or placebo with concomitant heparin anticoagulation. The by bedside echocardiography, [18,19,38] is associated with increased primary endpoint of the study was in-hospital death or need for in-hospital mortality in patients presenting with clinically suspectescalation of treatment, defined as catecholamine administration, ed PE. [39] These findings are in accordance with current theories emergency (late) thrombolysis, endotracheal intubation, cardiwhich emphasize that death due to acute PE is death resulting from opulmonary resuscitation, or emergency surgical embolectomy or right heart failure.…”

Section: Implications Of a Recent Randomized Thrombolysis Trial In Sumentioning

confidence: 99%

Should Thrombolytic Therapy Be Used in Patients with Pulmonary Embolism?

Konstantinides

2004

American Journal of Cardiovascular Drugs

Self Cite

View full text Add to dashboard Cite

More than thirty years have passed since streptokinase was first shown to dissolve pulmonary arterial thrombi and normalize pulmonary artery pressure in patients with acute pulmonary embolism (PE). Following the initial observations, a number of controlled clinical trials confirmed that treatment with streptokinase, urokinase or alteplase recombinant tissue plasminogen activator is superior to heparin alone in improving angiographic and hemodynamic parameters in these patients. At present, there is consensus that patients with massive PE presenting with overt right ventricular failure (clinical instability and cardiogenic shock) should promptly be treated with thrombolytic agents, since they are at a particularly high risk for death or life-threatening complications during the acute phase. At the other end of the clinical spectrum, thrombolysis for PE is not indicated in the absence of right ventricular dysfunction. In fact, the prognosis of patients with small pulmonary emboli (not affecting pulmonary artery pressure and right ventricular afterload), is excellent and, as a result, the bleeding risks of thrombolysis may outweigh the potential benefits of this treatment. Currently, the thrombolysis debate focuses on patients with submassive PE, i.e. those who present with signs of subclinical, impending right heart failure. Recently, a number of clinical studies demonstrated that these patients are also at risk for an adverse clinical outcome. Besides the established prognostic value of echocardiography, evidence is now accumulating that cardiac troponins and, possibly, pro-brain natriuretic peptide levels also may permit an early, reliable risk stratification of patients with PE and particularly help identify submassive PE in the presence of apparent clinical stability. Recently, the Management Strategies and Prognosis of Pulmonary Embolism-3 trial examined the effects of thrombolysis on the prognosis of patients with acute submassive PE. The study patients were randomly assigned to receive alteplase (100 mg over 2 hours) or placebo with concomitant heparin anticoagulation. Although in-hospital mortality was low in both the alteplase and the heparin-only group, this study showed for the first time that early treatment with alteplase can improve the clinical course of patients with acute submassive PE, and particularly reduce the need for emergency escalation of treatment. Importantly, no fatal or cerebral bleeding episodes were observed in the alteplase group. This fact indicates that use of thrombolysis in PE can be safe in patients who have no contraindications to this type of treatment. Based on these data, the indications for thrombolysis can be extended to include patients presenting with submassive PE.

show abstract

Role of Cardiac Ultrasound in the Detection of Pulmonary Embolism

Cited by 13 publications

References 94 publications

The case for thrombolysis in acute major pulmonary embolism: hemodynamic benefits and beyond

The case for thrombolysis in acute major pulmonary embolism: hemodynamic benefits and beyond

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

Should Thrombolytic Therapy Be Used in Patients with Pulmonary Embolism?

Contact Info

Product

Resources

About