Utility of an integrated clinical, echocardiographic, and venous ultrasonographic approach for triage of patients with suspected pulmonary embolism

Grifoni, Stefano; Olivotto, Iacopo; Cecchini, Paolo; Pieralli, Filippo; Camaiti, Alberto; Santoro, Gennaro; Pieri, Alessandro; Toccafondi, Simone; Magazzini, Simone; Bèrni, G; Agnelli, Giancarlo

doi:10.1016/s0002-9149(98)00612-2

Cited by 105 publications

(62 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Only a few studies have addressed prospectively the diagnostic accuracy of echocardiography in patients with suspected PE [75][76][77]. These studies have yielded conflicting results with broad sensitivity (51-93%) and specificity (82-94%) ranges.…”

Section: Echocardiographymentioning

confidence: 99%

See 1 more Smart Citation

Imaging techniques in treatment algorithms of pulmonary embolism

Pistolesi

Miniati²

2002

European Respiratory Journal

View full text Add to dashboard Cite

Imaging techniques in treatment algorithms of pulmonary embolism. M. Pistolesi, M. Miniati. #ERS Journals Ltd 2002. ABSTRACT: Pulmonary embolism (PE) is more often diagnosed post mortem by pathologists than in vivo by clinicians. The identification of practical diagnostic algorithms could reduce the rate of diagnoses first made at autopsy.The literature was reviewed for evidence-based approaches to PE diagnosis. Since the PE mortality rate greatly exceeds that of deep vein thrombosis (DVT), more emphasis was given to reports specifically dealing with PE diagnosis by objective pulmonary vascular imaging techniques than to those aimed at DVT detection.Several studies have shown that standardized clinical estimates can be effectively used to give a pretest probability to calculate, after appropriate objective testing, the post-test probability of PE. A prospective trial has shown that perfusion scanning, rather than ventilation/perfusion scanning, should be the imaging technique of first choice for the management of patients suspected of having PE. The clinical usefulness of spiral computed tomography has not as yet been firmly established. However, ongoing technological developments would probably render the technique accurate enough to replace conventional angiography.The authors propose a noninvasive diagnostic algorithm with high predictive accuracy (positive predictive value 96%; negative predictive value 98%) starting with a standardized assessment of clinical likelihood, followed by a perfusion scan and, eventually, spiral computed tomography in only a minority of patients (v20%) with discordant clinical and scintigraphic findings.

show abstract

Section: Echocardiographymentioning

confidence: 99%

“…Detection of right ventricular dysfunction in patients with PE is, conversely, of great clinical value in assessing the severity of disease and long-term prognosis [74,77,[79][80][81].…”

Section: Echocardiographymentioning

confidence: 99%

Imaging techniques in treatment algorithms of pulmonary embolism

Pistolesi

Miniati²

2002

European Respiratory Journal

View full text Add to dashboard Cite

show abstract

“…In approximately 50% of aPe patients, echocardiographic signs of RV systolic dysfunction can be detected [1]. Recently, systolic dysfunction has also been described as assessed by new echocardiographic techniques, such as tissue Doppler imaging (TDI) [2][3][4][5][6][7][8][9][10][11][12][13]. There are, however, limited studies on the diastolic function of the heart muscle in aPe patients [14][15][16][17].…”

mentioning

confidence: 99%

Assessment of Right and Left Ventricular Diastolic Functions with Tissue Doppler Echocardiography in Congestive Heart Failure Patients with Coexisting Acute Pulmonary Embolism

Gromadziński¹,

Targoński²,

Pruszczyk³

2014

Adv Clin Exp Med

View full text Add to dashboard Cite

Background. acute pulmonary embolism (aPe), despite improvements in diagnostic methods, often remains undiagnosed. Recently, systolic dysfunction has also been described as assessed by new echocardiographic techniques, such as tissue Doppler imaging (TDI). Objectives. In our study we have attempted to assess diastolic function within the mitral and tricuspid annuli in congestive heart failure (cHf) patients with coexisting aPe. Material and Methods. The study included 39 patients with cHf with sinus rhythm, 20 patients with confirmed aPe (Pe+), and 19 patients with excluded aPe (Pe-). aPe was confirmed or excluded on the result of spiral chest computed tomography. Tissue Doppler imaging (TDI) was performed to measure early diastolic velocity (em), late diastolic velocity (am) of both examined annuli, and em/amLV and em/amRV ratios. Results. Pe+ subjects were found to have lower emRV than Pe-subjects . for the aPe diagnosis, the area under the ROc curve calculated for amLV and em/amLV was 0.771 (95% cI 0.509-0.890) and 0.742 (95% cI 0.577-0.868) respectively. for the aPe diagnosis, the sensitivity, specificity, positive and negative predictive values for amLV = 4.9 cm/s were: 95%, 68.4%, 76% and 92.9%, respectively and for em/amLV = 1.0 were: 95%, 63.2%, 73.1% and 92.3%, respectively. Conclusions. TDI reveals changes in mitral and tricuspid annular velocities in cHf patients with confirmed aPe. These patients exhibit a reduced emRV and increased amLV (Adv Clin Exp Med 2014, 23, 3, 371-376).

show abstract

“…Whereas echocardiography plays predominantly a prognostic role for patients at a low risk of early death [3]. Generally accepted parameters for the assessment of RV pressure overload include: dilatation of the RV, hypokinesia of the RV walls with the McConnell's sign, 60/60 sign, RV/LV ratio > 1.0 and decreased TAPSE [4][5][6][7][8]. However a precise cut off values of these parameters remain to be defi ned.…”

mentioning

confidence: 99%