Doppler Echocardiographie Assessment of the Severity of Acute
Pulmonary Embolism

Metz, Damien; Chapoutot, L; Ouzan, J; Chabert, Jean-Pierre; Pollet, Éric; Elaerts, J; Bajolet, A

doi:10.1159/000470446

Cited by 17 publications

(11 citation statements)

References 11 publications

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“…6 reported on good agreement between systolic pulmonary arterial pressure and its Doppler estimate based on continuous wave Doppler measurement of the tricuspid jet velocity (r=0.91) which was possible in 52 of 56 patients with pulmonary embolism. It is interesting that the correlation coefficient between Miller's index of pulmonary vascular obstruction and tricuspid jet velocity was lower than that between Miller's index and the ratio of diameters of right to left ventricle as measured with echocardiography (r = 0.43 and 0.68, respectively).…”

Section: Doppler Findings In Acute Pulmonary Embolismmentioning

confidence: 95%

Role of echo/doppler in the diagnosis of pulmonary embolism

Torbicki

Tramarin²,

Morpurgo

1992

Clinical Cardiology

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Summary: Echocardiography supplemented with pulsed and continuous wave Doppler facilities is a potent diagnostic tool in many cardiovascular disorders. Its potential role in the management of patients with suspected pulmonary embolism, though less extensively studied, deserves attention. Benefits of echoDoppler in these patients are as follows:(1) Echo/Doppler is a noninvasive, relatively inexpensive technique, readily available and repeatable in critically ill patients at the bedside.(2) EchdDoppler provides a number of independent parameters related to the pulmonary hemodynamics. These parameters include: (a) characteristics of blood flow velocity curves across the right heart valves as well as systolic and diastolic time intervals of the right ventricle (b) motion pattern of the interventricular septum (c) dimensions of the heart chambers and inferior (d) thickness of the right ventricular free wall (3) Echocardiography allows detection of thrombi within right heart chambers or in major branches of the pulmonary artery in some patients.(4) EchdDoppler may disclose alternative abnormalities explaining symptoms found in a patient with suspected pulmonary embolism such as pericardjal disease, myocardial infarction, aortic dissection, hypovolemic shock, etc. Echocardiographic Changes in Acute Pulmonary Embolism Acute Right Ventricular Pressure OverloadThe main role of echocardiography in patients with suspected pulmonary embolism is to disclose signs of acute right ventricular (RV) pressure overload andor failure. Pulmonary embolism will result in such hemodynamic changes when at least 3 0 4 0 % of the pulmonary arterial bed is obliterated.'T2 Therefore, claims of high sensitivity of echocardiographic diagnosis of pulmonary embolism are not realistic. Nevertheless, Kasper et aL3 found important echocardiographic changes in the majority of 105 consecutive patients with pulmonary embolism confirmed by angiography (n = 48), autopsy (n = 6), or high-probability lung perfusion scan (n= 51). Echocardiographic findings consisted of enlarged right ventricle (defined as RVEDD > 27 mm) in 75% of patients, reduced left ventricular diastolic dimension (LVEDD < 36mm) in 42%, decreased EF slope of the mitral valve ( 4 0 m d s ) in 50%, and dilated right pulmonary artery (>1 l .4 mm/m2) in 77%. Abnormal septal motion was observed in 44% of patients. All the above parameters were within the normal range in only 19 of 105 (18%) patients. However, no comparison with a control group was made. The authors developed a score used to establish an echocardiographic severity index of pulmonary embolism based on the five echocardiographic signs listed above, which scored 1 when at the upper limits of normal and 2 when abnormal. A significant correlation was found when this echocardiographic score was compared with the angiographic severity index of embolic obstruction according to Walsh et al.4 (n = 36, r = 0.72, p

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Section: Doppler Findings In Acute Pulmonary Embolismmentioning

confidence: 95%

Role of echo/doppler in the diagnosis of pulmonary embolism

Torbicki

Tramarin²,

Morpurgo

1992

Clinical Cardiology

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“…The Doppler sPAP assessment seems to be very reli able however; the correlation between sPAP obtained through catheterization and those calculated by Doppler is very good in several studies [7,16] and confirmed in acute PE [4]. The clinical evaluation of the RAP, which seems to be a potential limitation of the present analysis, has been validated in a previous study [17],…”

Section: Protocolmentioning

confidence: 67%

“…It is usually estimated from the cardiac output and the mean (m) PAP obtained through catheter ization [ 12] and by study of the pulmonary or total artery resistances [8,13], Our study used the Doppler sPAP cal culation from the TR flow, nearly constantly present in PE [4] and easy to record with CW Doppler. On the other hand, the recording of the pulmonary regurgitation…”

Section: Discussionmentioning

confidence: 99%

“…The aim of this prospective study was to evaluate the reliability of the imaging and Doppler échocardiographie parameters of the PE [3][4][5] in assessing the efficacy of fibrinolysis. The evolution under treatment of the right ventricular dysfunction and the systolic pulmonary artery pressure was compared with the evolution of the angio graphic variables.…”

Section: Methodsmentioning

confidence: 99%

“…Many previous studies have demonstrated the reliable relation ship between the importance of the échographie signs and the extent of the pulmonary obstruction [3,4],…”

Section: Introductionmentioning

confidence: 98%

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Value and Limits of Doppler Ultrasound and M-Mode Echocardiography in the Assessment of the Efficacy of Fibrinolysis in Pulmonary Embolism

Chapoutot¹,

Metz²,

Chabert³

et al. 1992

Am J Noninvas Cardiol

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The efficacy of fibrinolytic therapies in pulmonary embolism (PE) was prospectively studied by Doppler echocardiography (DE). The evolution of the imaging and Doppler echographic parameters was compared with the angiographic evolution. Twenty-two patients presenting a severe PE with a vascular obstruction percentage (VOP) of more than 40% were included in the study. The following parameters were recorded before and after thrombolysis: the systolic pulmonary arterial pressure (sPAP) was assessed from the tricuspid regurgitation (TR) flow using continuous-wave (CW) Doppler, and the right and left ventricular diastolic diameters (RVD and LVD) were measured using echographie M-mode examination. All the PE were severe (VOP = 68 ± 10%) with pulmonary hypertension (sPAP = 53.5 ± 10 mm Hg). The improvement of the VOP averages 34%. The average sPAP dropped from 53.5 ± 10 to 34.5 ± 11 mm Hg and the RVD from 31.5 ± 6.5 to 25 ± 5.5 mm. The LVD rose from 39.5 ± 7 to 43.5 ± 6 mm. The RV/LV ratio dropped from 0.82 to 0.59 (p < 0.005). In 6 cases, the treatment was proved inefficient at the angiographic control with an improvement of the VOP inferior to 20%. The persistence of a pulmonary hypertension at the control CW signed an angiographic failure of the fibrinolysis. Whereas the regression of the pulmonary hypertension was an inconstant sign of an angiographic success, the reduction of the right ventricular diameter was a sure indication of a significant pulmonary reperfusion.

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