Unlocking the power of echocardiography: strategies in risk stratification of patients with PE using echocardiography | ||
| Cardiovascular Biomedicine | ||
| Volume 4, Issue 1, August 2024, Pages 10-20 PDF (715.55 K) | ||
| Document Type: Original articles | ||
| DOI: 10.18502/cbj.v4i1.16222 | ||
| Authors | ||
| Venous Shahabi Raberi1; Negar Jafari2; Reza Faramarz Zadeh1; Razieh Parizad3, 4; Ozra Kahourian* 1 | ||
| 1Seyed-Al-Shohada cardiology Hospital, Urmia University of Medical Sciences, Urmia, Iran | ||
| 2Department of Cardiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran | ||
| 3Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran | ||
| 4Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran | ||
| Abstract | ||
| Objectives: Pulmonary embolism (PE) is challenging to diagnose due to nonspecific symptoms. While computed tomography pulmonary angiography (CTPA) is the gold standard, transthoracic echocardiography (TTE) is frequently used first. This study aimed to evaluate the accuracy of TTE findings in predicting the severity of CTPA-confirmed PE. Methods: This retrospective study in 2023, analyzed 124 patients who underwent CTPA for suspected PE at Seyed Al Shohada Hospital of Urmia, Iran. The Pulmonary Embolism Severity Index (PESI), as a risk stratification tool for pulmonary embolism, was measured in the first hours of hospitalization. TTE was performed 48 hours following hospital admission, with an emphasis on Key TTE parameters, including McConnell’s sign, D-shape septum sign, right ventricular (RV) dimensions, left ventricular dimensions, pulmonary artery (PA) diameter, tricuspid regurgitation gradient (TRG), Tricuspid annular plane systolic excursion (TAPSE) and PA acceleration time (PaACT). Sensitivity, specificity and predictive value were all calculated. Results: Most patients were women (53.23%) over 60 (38.71%). Several TTE measures showed promise for predicting PE: RV dilation (sensitivity 84%, specificity 77%), PA diameter (84% and 28%), TRG (66% and 58%), and PA acceleration time (92% and 62%). However, McConnell’s sign had low accuracy (area under ROC curve 0.62). Tricuspid annular plane systolic excursion (TAPSE) and PA acceleration time showed the best predictive performance (AUC 0.95-0.92) and can be used as screening tools for life-threatening massive PE.PESI index test, when compared to the gold standard CT scan (which shows lung involvement), does not provide additional valuable information and accurate predictions about the severity of PE. Conclusions: TAPSE and PaACT showed excellent predictive ability to CTPA-detected PE. RV dilation and PA diameter also showed good predictive capability. Findings support using some TTE indices to screen for PE severity and risk assessment before CTPA when access is limited. | ||
| Keywords | ||
| pulmonary embolism; echocardiography; computed tomography pulmonary angiography; diagnostic accuracy; tricuspid annular plane systolic excursion; pulmonary artery acceleration time | ||
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