Prognostic Value of Emergency Physician Performed Echocardiography in Patients with Acute Pulmonary Thromboembolism
Introduction: Pulmonary embolism (PE) is a life-threatening illness with high morbidity and mortality. Echocardiography (ECG) plays an important role in the early identification of right ventricular (RV) dysfunction, making it a helpful tool in identifying hemodynamically stable patients affected by...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
eScholarship Publishing, University of California
2013-09-01
|
| Series: | Western Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | http://escholarship.org/uc/item/0k25z8rk# |
| _version_ | 1828836078531903488 |
|---|---|
| author | Maurizio Zanobetti Cristiano Converti Alberto Conti Gabriele Viviani Elisa Guerrini Vanessa Boni Sonia Vicidomini Claudio Poggioni Aurelia Guzzo Alessandro Coppa Sofia Bigiarini Francesca Innocenti Riccardo Pini |
| author_facet | Maurizio Zanobetti Cristiano Converti Alberto Conti Gabriele Viviani Elisa Guerrini Vanessa Boni Sonia Vicidomini Claudio Poggioni Aurelia Guzzo Alessandro Coppa Sofia Bigiarini Francesca Innocenti Riccardo Pini |
| author_sort | Maurizio Zanobetti |
| collection | DOAJ |
| description | Introduction: Pulmonary embolism (PE) is a life-threatening illness with high morbidity and mortality. Echocardiography (ECG) plays an important role in the early identification of right ventricular (RV) dysfunction, making it a helpful tool in identifying hemodynamically stable patients affected by PE with a higher mortality risk. The purpose of this study was to evaluate if one or more ECG indexes could predict a short-term evolution towards RV dysfunction.Methods: We selected all patients consecutively admitted to the Careggi Hospital Emergency Department with the clinical suspicion of PE, confirmed by computed tomography angiography prior to enrollment. Subsequently, properly trained emergency physicians acquired a complete ECG to measure RV morphological and functional indices. For each patient, we recorded if he or she received a fibrinolytic treatment, a surgical embolectomy or heparin therapy during the emergency department (ED) stay. Then, every patient was re-evaluated with ECG, by the same physician, after 1 week in our intensive observation unit and 1 month as outpatient in our ED regional referral center for PE.Results: From 2002 to 2007, 120 consecutive patients affected by PE were evaluated by echocardiography at the Careggi Hospital ED. Nine patients (8%) were treated with thrombolytic therapy. Six died within 1 week and 4 abandoned the study, while the remaining 110 survived and were re-evaluated by ECG after 1 week and 1 month. The majority of the echocardiographic RV indexes improve mostly in the first 7 days: Acceleration Time (AT) from 78±14 ms to 117±14 ms (p<0.001), Diameter of Inferior Vena Cava (DIVC) from 25±6 mm to 19±5 mm (p<0.001), Tricuspid Annular Plane Systolic Excursion (TAPSE) from 16±6 mm to 20±6 mm (p<0.001). Pulmonary Artery Systolic Pressure (PASP) showed a remarkable decrease from 59±26 mmHg to 37±9 mmHg, (p<0.001). The measurements of the transverse diameters of both ventricles and the respective ratio showed a progressive normalization with a reduction of RV diameter, an increase of Left Ventricular (LV) diameter and a decrease of RV/LV ratio over time. To evaluate the RV function, the study population was divided into 3 groups based on the TAPSE and PASP mean values at the admission: Group 1 (68 patients) (TAPSE+/ PASP-), Group 2 (12 patients) (TAPSE-/PASP-), and Group 3 (30 patients) (TAPSE-/PASP+). Greater values of AT, minor RV diameter, greater LV diameter and a lesser RV/LV ratio were associated with a short-term improvement of TAPSE in the Group 2. Instead, in Group 3 the only parameter associated with short-term improvement of TAPSE and PASP was the treatment with thrombolytic therapy (p<0.0001).Conclusion: Greater values of AT, minor RV diameter, greater LV diameter and a lesser RV/LV ratio were associated with a short-term improvement of TAPSE-/PASP- values. Patients with evidence of RV dysfunction (TAPSE-/PASP+), may benefit from thrombolytic therapy to improve a short- term RV function. After 1 month, also a decreased DIVC predicted improved RV function. [West J Emerg Med. 2013;14(5):509–517.] |
| first_indexed | 2024-12-12T18:15:27Z |
| format | Article |
| id | doaj.art-eb8af320deef4a8f870ee5756fb05e98 |
| institution | Directory Open Access Journal |
| issn | 1936-900X 1936-9018 |
| language | English |
| last_indexed | 2024-12-12T18:15:27Z |
| publishDate | 2013-09-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-eb8af320deef4a8f870ee5756fb05e982022-12-22T00:16:17ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182013-09-0114550951710.5811/westjem.2013.4.12690Prognostic Value of Emergency Physician Performed Echocardiography in Patients with Acute Pulmonary ThromboembolismMaurizio ZanobettiCristiano ConvertiAlberto ContiGabriele VivianiElisa GuerriniVanessa BoniSonia VicidominiClaudio PoggioniAurelia GuzzoAlessandro CoppaSofia BigiariniFrancesca InnocentiRiccardo PiniIntroduction: Pulmonary embolism (PE) is a life-threatening illness with high morbidity and mortality. Echocardiography (ECG) plays an important role in the early identification of right ventricular (RV) dysfunction, making it a helpful tool in identifying hemodynamically stable patients affected by PE with a higher mortality risk. The purpose of this study was to evaluate if one or more ECG indexes could predict a short-term evolution towards RV dysfunction.Methods: We selected all patients consecutively admitted to the Careggi Hospital Emergency Department with the clinical suspicion of PE, confirmed by computed tomography angiography prior to enrollment. Subsequently, properly trained emergency physicians acquired a complete ECG to measure RV morphological and functional indices. For each patient, we recorded if he or she received a fibrinolytic treatment, a surgical embolectomy or heparin therapy during the emergency department (ED) stay. Then, every patient was re-evaluated with ECG, by the same physician, after 1 week in our intensive observation unit and 1 month as outpatient in our ED regional referral center for PE.Results: From 2002 to 2007, 120 consecutive patients affected by PE were evaluated by echocardiography at the Careggi Hospital ED. Nine patients (8%) were treated with thrombolytic therapy. Six died within 1 week and 4 abandoned the study, while the remaining 110 survived and were re-evaluated by ECG after 1 week and 1 month. The majority of the echocardiographic RV indexes improve mostly in the first 7 days: Acceleration Time (AT) from 78±14 ms to 117±14 ms (p<0.001), Diameter of Inferior Vena Cava (DIVC) from 25±6 mm to 19±5 mm (p<0.001), Tricuspid Annular Plane Systolic Excursion (TAPSE) from 16±6 mm to 20±6 mm (p<0.001). Pulmonary Artery Systolic Pressure (PASP) showed a remarkable decrease from 59±26 mmHg to 37±9 mmHg, (p<0.001). The measurements of the transverse diameters of both ventricles and the respective ratio showed a progressive normalization with a reduction of RV diameter, an increase of Left Ventricular (LV) diameter and a decrease of RV/LV ratio over time. To evaluate the RV function, the study population was divided into 3 groups based on the TAPSE and PASP mean values at the admission: Group 1 (68 patients) (TAPSE+/ PASP-), Group 2 (12 patients) (TAPSE-/PASP-), and Group 3 (30 patients) (TAPSE-/PASP+). Greater values of AT, minor RV diameter, greater LV diameter and a lesser RV/LV ratio were associated with a short-term improvement of TAPSE in the Group 2. Instead, in Group 3 the only parameter associated with short-term improvement of TAPSE and PASP was the treatment with thrombolytic therapy (p<0.0001).Conclusion: Greater values of AT, minor RV diameter, greater LV diameter and a lesser RV/LV ratio were associated with a short-term improvement of TAPSE-/PASP- values. Patients with evidence of RV dysfunction (TAPSE-/PASP+), may benefit from thrombolytic therapy to improve a short- term RV function. After 1 month, also a decreased DIVC predicted improved RV function. [West J Emerg Med. 2013;14(5):509–517.]http://escholarship.org/uc/item/0k25z8rk#pulmonary embolismechocardiographyemergency departmentright ventricular disfunctionthrombolytic therapyemergency medicinecardiology |
| spellingShingle | Maurizio Zanobetti Cristiano Converti Alberto Conti Gabriele Viviani Elisa Guerrini Vanessa Boni Sonia Vicidomini Claudio Poggioni Aurelia Guzzo Alessandro Coppa Sofia Bigiarini Francesca Innocenti Riccardo Pini Prognostic Value of Emergency Physician Performed Echocardiography in Patients with Acute Pulmonary Thromboembolism Western Journal of Emergency Medicine pulmonary embolism echocardiography emergency department right ventricular disfunction thrombolytic therapy emergency medicine cardiology |
| title | Prognostic Value of Emergency Physician Performed Echocardiography in Patients with Acute Pulmonary Thromboembolism |
| title_full | Prognostic Value of Emergency Physician Performed Echocardiography in Patients with Acute Pulmonary Thromboembolism |
| title_fullStr | Prognostic Value of Emergency Physician Performed Echocardiography in Patients with Acute Pulmonary Thromboembolism |
| title_full_unstemmed | Prognostic Value of Emergency Physician Performed Echocardiography in Patients with Acute Pulmonary Thromboembolism |
| title_short | Prognostic Value of Emergency Physician Performed Echocardiography in Patients with Acute Pulmonary Thromboembolism |
| title_sort | prognostic value of emergency physician performed echocardiography in patients with acute pulmonary thromboembolism |
| topic | pulmonary embolism echocardiography emergency department right ventricular disfunction thrombolytic therapy emergency medicine cardiology |
| url | http://escholarship.org/uc/item/0k25z8rk# |
| work_keys_str_mv | AT mauriziozanobetti prognosticvalueofemergencyphysicianperformedechocardiographyinpatientswithacutepulmonarythromboembolism AT cristianoconverti prognosticvalueofemergencyphysicianperformedechocardiographyinpatientswithacutepulmonarythromboembolism AT albertoconti prognosticvalueofemergencyphysicianperformedechocardiographyinpatientswithacutepulmonarythromboembolism AT gabrieleviviani prognosticvalueofemergencyphysicianperformedechocardiographyinpatientswithacutepulmonarythromboembolism AT elisaguerrini prognosticvalueofemergencyphysicianperformedechocardiographyinpatientswithacutepulmonarythromboembolism AT vanessaboni prognosticvalueofemergencyphysicianperformedechocardiographyinpatientswithacutepulmonarythromboembolism AT soniavicidomini prognosticvalueofemergencyphysicianperformedechocardiographyinpatientswithacutepulmonarythromboembolism AT claudiopoggioni prognosticvalueofemergencyphysicianperformedechocardiographyinpatientswithacutepulmonarythromboembolism AT aureliaguzzo prognosticvalueofemergencyphysicianperformedechocardiographyinpatientswithacutepulmonarythromboembolism AT alessandrocoppa prognosticvalueofemergencyphysicianperformedechocardiographyinpatientswithacutepulmonarythromboembolism AT sofiabigiarini prognosticvalueofemergencyphysicianperformedechocardiographyinpatientswithacutepulmonarythromboembolism AT francescainnocenti prognosticvalueofemergencyphysicianperformedechocardiographyinpatientswithacutepulmonarythromboembolism AT riccardopini prognosticvalueofemergencyphysicianperformedechocardiographyinpatientswithacutepulmonarythromboembolism |