Bedside Echocardiography in the Diagnosis of Patients with Suspected Pulmonary Embolism_Chinese Journal of Evidence-Based Medicine

Authors：

 ZHANGRui ¹ , WANLin ¹ , FENGXiao-lei ² , PANLong-fei ¹ , PENGZhuo ¹ , SUNJiang-li ¹ ,  DANGXiao-yan ¹

1. Department of Emergency, the Second Afflicted Hospital of Xi'an Jiaotong University, Xi'an 710004, China;
2. Department of Ultrasound, the Second Afflicted Hospital of Xi'an Jiaotong University, Xi'an 710004, China;

Corresponding author：

DANGXiao-yan, Email: dxiaoyanl@163.com

Keywords：

Bedside echocardiography; Acute pulmonary embolism; Wells score

DOI：

10.7507/1672-2531.20160170

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the diagnostic value of the bedside echocardiogram for different risk stratification of patients with suspected pulmonary embolism. Methods Patients with suspected pulmonary embolism in the emergency department of the Second Afflicted Hospital Xi'an Jiaotong University between July 2013 to December 2015 were included. According the Wells scores, they were divided into a low risk group (0-2 points), a intermediate risk group (3-6 points) and a high risk group (>6 points). All patients were underwent the bedside echocardiogram diagnosis, and the diagnostic value of the echocardiography for pulmonary embolism, the characteristics of different risk stratification of patients were analyzed by SPSS 18.0 software. Results 115 patients with suspected pulmonary embolism were included, of which 20 were in the low risk group, 73 were in the medium risk group, and 22 were in the high risk group. The incidence of pulmonary embolism among the three groups was significantly different (high-risk vs. medium risk vs. low-risk: 90.9% vs. 76.7% vs. 15.0%, P<0.05), and the higher Wells scores gets, the greater possibility of having the pulmonary embolism. For the intermediate-risk group, the incidence of pulmonary embolism was significantly higher in patients with positive ultrasonic results than those with the negative ultrasonic results (87.3% vs. 44.4%, P<0.05). The predication of the ultrasonic positive and the negative in the low and high risk groups had no statistical differences (P>0.05). The result of echocardiogram showed that the right ventricular end-diastolic diameter, right ventricular end-diastolic transverse diameter, right atrial end-diastolic transverse diameter, RV/LV, RA/LA in the high risk group and the intermediate risk group were significantly higher than those in the low risk group (all P values <0.05). The right ventricular anterior wall activity in the low risk group was higher than that in the high risk group (P<0.05), but this difference was not found between the high risk group and the intermediate risk group. Conclusion Bedside echocardiogram can be used as the diagnosis and differential diagnosis methods of suspected pulmonary embolism, and it has relatively higher diagnostic value for intermediate to high risk patients predicted by the Wells scores than low risk ones.

Citation： ZHANGRui, WANLin, FENGXiao-lei, PANLong-fei, PENGZhuo, SUNJiang-li, DANGXiao-yan. Bedside Echocardiography in the Diagnosis of Patients with Suspected Pulmonary Embolism. Chinese Journal of Evidence-Based Medicine, 2016, 16(10): 1117-1120. doi: 10.7507/1672-2531.20160170 Copy

1.	Saleh JA, Shovlin C, Alasia DD. Acute pulmonary embolism: a review. Niger J Med, 2007, 16(1): 11-17.
2.	Tapson VF. Acute pulmonary Embolism. N Engl J Med, 2008, 358: 1307.
3.	Ward MJ, Sodickson A, Diercks DB, et al. Cost-effectiveness of lower extermity compression ultrasound in emergency department patients with a high risk of hemodynamically stable pulmonary embolism. Acad Emerg Med, 2011, 18(1): 22.
4.	Konstantinides SV, Torbicki A, Perrier A, et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J, 2014, 35(43): 3033-3069.
5.	Wells PS, Anderson DR, Rodger M, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost, 2000, 83(3): 416-420.
6.	倪显达, 谢于鹏, 卢中秋, 等. 急性床旁超声心动图在急性肺栓塞诊断中的应用. 温州医学院学报, 2004, 4(34): 278-279.
7.	苏剑, 田红英, 程勇. 64层螺旋CT血管造影诊断中度疑似肺栓塞的临床价值. 临床影像技术, 2011, 26(9): 152-154.
8.	Taniguchi T, Kato M, Ueda S, et al. Prevalence and significance of clinically unsuspected pulmonary embolism: detection using coronary computed tomography angiography. J Card Surg, 2015, 30(4): 301-316.
9.	Wicki J, Perneger TV, Junod AF, et al. Assessing clinical probability of pulmonary embolism in the emergency ward: a simple score. Arch Intern Med, 2001, 161(1): 92-97.
10.	Le Gal G, Righini M, Roy PM, et al. Prediction of pulmonary embolism in the Emergency Department: The Revised Geneva Score. Ann Intern Med, 2006, 144(3): 165-171.
11.	Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology(ESC). Eur Heart J, 2008, 29(18): 2276-2315.
12.	王建国, 朱力, 刘敏, 等. 三种急性肺栓塞评分预测价值比较分析. 中国实用内科杂志, 2009, 29(4): 322-324.
13.	纳建荣, 周玮. Wells评分对临床诊断肺栓塞的应用价值. 宁夏医学杂志, 2012, 4(3): 330-331.
14.	Wicki J, Perneger TV, Junod AF, et al. Assessing clinical probability of pulmonary embolism in the emergency ward: a simple score. Arch Intern Med, 2001, 161(1): 92-97.
15.	British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax, 2003, 58(6): 470-483.
16.	朴雪梅. 床旁超声心动图对急性肺栓塞的应用价值分析. 中外医疗, 2013, 21: 175-176.
17.	Ward MJ, Sodickson A, Diercks DB, et al. Cost-effectieness of lower Extremity High risk of hemodynamically stable Pulmonary Embolism. Acad Emerg Med, 2011, 18(1): 22-31.
18.	吴雅峰, 胡大一, 徐琳, 等. 多普勒超声心动图对急性肺栓塞特点及分析. 中华超声影像学杂志, 2001, 10(6): 341-343.
19.	Casazza F, Bongarzoni A, Capozi A, et al. Regional right ventricular dysfunction in actue pulmonary embolism and right ventricular infarction. Eur J Echocardio, 2009, 6(3): 11-14.

1. Saleh JA, Shovlin C, Alasia DD. Acute pulmonary embolism: a review. Niger J Med, 2007, 16(1): 11-17.
2. Tapson VF. Acute pulmonary Embolism. N Engl J Med, 2008, 358: 1307.
3. Ward MJ, Sodickson A, Diercks DB, et al. Cost-effectiveness of lower extermity compression ultrasound in emergency department patients with a high risk of hemodynamically stable pulmonary embolism. Acad Emerg Med, 2011, 18(1): 22.
4. Konstantinides SV, Torbicki A, Perrier A, et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J, 2014, 35(43): 3033-3069.
5. Wells PS, Anderson DR, Rodger M, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost, 2000, 83(3): 416-420.
6. 倪显达, 谢于鹏, 卢中秋, 等. 急性床旁超声心动图在急性肺栓塞诊断中的应用. 温州医学院学报, 2004, 4(34): 278-279.
7. 苏剑, 田红英, 程勇. 64层螺旋CT血管造影诊断中度疑似肺栓塞的临床价值. 临床影像技术, 2011, 26(9): 152-154.
8. Taniguchi T, Kato M, Ueda S, et al. Prevalence and significance of clinically unsuspected pulmonary embolism: detection using coronary computed tomography angiography. J Card Surg, 2015, 30(4): 301-316.
9. Wicki J, Perneger TV, Junod AF, et al. Assessing clinical probability of pulmonary embolism in the emergency ward: a simple score. Arch Intern Med, 2001, 161(1): 92-97.
10. Le Gal G, Righini M, Roy PM, et al. Prediction of pulmonary embolism in the Emergency Department: The Revised Geneva Score. Ann Intern Med, 2006, 144(3): 165-171.
11. Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology(ESC). Eur Heart J, 2008, 29(18): 2276-2315.
12. 王建国, 朱力, 刘敏, 等. 三种急性肺栓塞评分预测价值比较分析. 中国实用内科杂志, 2009, 29(4): 322-324.
13. 纳建荣, 周玮. Wells评分对临床诊断肺栓塞的应用价值. 宁夏医学杂志, 2012, 4(3): 330-331.
14. Wicki J, Perneger TV, Junod AF, et al. Assessing clinical probability of pulmonary embolism in the emergency ward: a simple score. Arch Intern Med, 2001, 161(1): 92-97.
15. British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax, 2003, 58(6): 470-483.
16. 朴雪梅. 床旁超声心动图对急性肺栓塞的应用价值分析. 中外医疗, 2013, 21: 175-176.
17. Ward MJ, Sodickson A, Diercks DB, et al. Cost-effectieness of lower Extremity High risk of hemodynamically stable Pulmonary Embolism. Acad Emerg Med, 2011, 18(1): 22-31.
18. 吴雅峰, 胡大一, 徐琳, 等. 多普勒超声心动图对急性肺栓塞特点及分析. 中华超声影像学杂志, 2001, 10(6): 341-343.
19. Casazza F, Bongarzoni A, Capozi A, et al. Regional right ventricular dysfunction in actue pulmonary embolism and right ventricular infarction. Eur J Echocardio, 2009, 6(3): 11-14.

Next Article
Investigating the Glycated Hemoglobin HbA1c Concentration and Reference Range of Healthy Adults in Quanzhou

Chinese Journal of Evidence-Based Medicine

Bedside Echocardiography in the Diagnosis of Patients with Suspected Pulmonary Embolism

Abstract Full text Figures/Tables Video References Cited by

Next Article

Format

Content