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Vol. 43. Issue 9.
Pages 490-494 (January 2007)
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Vol. 43. Issue 9.
Pages 490-494 (January 2007)
Original Articles
DOI: 10.1016/S1579-2129(07)60113-X
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Prognostic Value of Transthoracic Echocardiography in Hemodynamically Stable Patients With Acute Symptomatic Pulmonary Embolism
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David Jiméneza,
Corresponding author
djc_69_98@yahoo.com

Correspondence: Dr. D. Jiménez Castro. Servicio de Neumología. Hospital Ramón y Cajal. Ctra. de Colmenar, km 9,100. 28034 Madrid. España
, Carlos Escobarb, David Martíb, Gema Díazc, Rafael Vidala, Dolores Taboadab, Javier Ortegab, José Luis Moyab, Vicencio Barriosb, Antonio Sueiroa
a Servicio de Neumología, Hospital Ramón y Cajal, Madrid, Spain
b Unidad de Ecocardiografía, Servicio de Cardiología, Hospital Ramón y Cajal, Madrid, Spain
c Servicio de Neumología, Hospital La Zarzuela, Madrid, Spain
Article information
Objective

To determine the prognostic value of transthoracic echocardiography in hemodynamically stable patients diagnosed with acute symptomatic pulmonary embolism.

Patients and methods

Hemodynamically stable outpatients diagnosed with acute symptomatic pulmonary embolism at a tertiary university hospital were prospectively included in the study. All patients underwent transthoracic echocardiography within 48 hours of diagnosis. The primary endpoint was all-cause mortality at 1 month.

Results

Right ventricular dysfunction was documented by echocardiography in 86 of the 214 patients (40%) in our series. In the first month of follow-up, 7 patients died—4 with positive echocardiographic findings and 3 with negative findings (odds ratio, 2.0; 95% confidence interval, 0.4-9.3; P =.41). For the primary endpoint, the negative predictive value of transthoracic echocardiography was 98%, the positive predictive value was 5%, and the negative likelihood ratio was 0.7. The negative predictive value was 100% and the positive predictive value was 3% when we analyzed death due to pulmonary embolism only.

Conclusions

In our setting, transthoracic echocardiography is not useful for prognostic stratification of hemodynamically stable patients with pulmonary embolism.

Key words:
Pulmonary embolism
Prognosis
Echocardiography
Objetivo

El objetivo de este estudio ha sido evaluar el valor pronóstico de la ecocardiografía transtorácica en pacientes estables hemodinámicamente con diagnóstico de tromboembolia pulmonar (TEP) aguda sintomática.

Pacientes y métodos

Se incluyó prospectivamente en el estudio a todos los pacientes ambulatorios, estables hemodinámicamente, diagnosticados de TEP aguda sintomática en un hospital universitario terciario. Se realizó a todos ellos una ecocardiografía transtorácica en las 48 h posteriores al diagnóstico. El criterio de evaluación principal fue la muerte por todas las causas a un mes.

Resultados

La prevalencia de criterios ecocardiográficos de disfunción del ventrículo derecho fue de un 40% en nuestra serie (86/214). Durante el primer mes de seguimiento se produjeron 7 fallecimientos, 4 en el grupo con ecocardiografía positiva y 3 en el grupo con ecocardiografía negativa (odds ratio = 2,0; intervalo de confianza del 95%, 0,4-9,3; p = 0,41). La ecocardiografía transtorácica demostró un valor predictivo negativo del 98%, un valor predictivo positivo del 5% y un cociente de probabilidad negativo de 0,7 respecto al parámetro de valoración principal. Cuando sólo se consideró la muerte por TEP, el valor predictivo negativo fue del 100% y el valor predictivo positivo, del 3%.

Conclusiones

En nuestro medio la ecocardiografía transtorácica carece de utilidad en la estratificación pronóstica de los pacientes estables hemodinámicamente con TEP.

Palabras clave:
Tromboembolia pulmonar
Pronóstico
Ecocardiografía
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REFERENCES
[1]
SZ Goldhaber.
Cardiac biomarkers in pulmonary embolism.
Chest, 123 (2003), pp. 1782-1784
[2]
A Vieillard Baron, B Page, R Augarde, S Prin, S Qanadli, et al.
Acute cor pulmonale embolism: incidence, echocardiographic pattern, clinical implications and recovery rate.
Intensive Care Med, 27 (2001), pp. 1481-1486
[3]
H Büller, G Agnelli, RD Hull, TM Hyers, MH Prins, GE Raskob.
Antithrombotic therapy for venous thromboembolic disease.
[4]
British Thoracic Society guidelines for the management of suspected acute pulmonary embolism.
Thorax, 58 (2003), pp. 470-483
[5]
JD Douketis, C Kearon, S Bates, EK Duku, JS Ginsberg.
Risk of fatal pulmonary embolism in patients with treated venous thromboembolism.
JAMA, 279 (1998), pp. 458-462
[6]
JL Carson, MA Kelley, A Duff, JG Weg, HI Palevssky, JS Schwartz, et al.
The clinical course of pulmonary embolism.
N Engl J Med, 326 (1992), pp. 1240-1245
[7]
EJ de Rosa, PM Kuijer, HR Büller, DP Brandjes, PM Bossuyt, JW ten Cate.
The clinical course of patients with suspected pulmonary embolism.
Arch Intern Med, 157 (1997), pp. 2593-2598
[8]
SZ Goldhaber, L Visani, M de Rosa.
Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER).
Lancet, 353 (1999), pp. 1386-1389
[9]
SZ Goldhaber, WD Haire, ML Feldstein, M Miller, R Toltzis, JL Smith, et al.
Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing RV function and pulmonary perfusion.
Lancet, 341 (1993), pp. 507-511
[10]
S Konstantinides, A Geibel, G Heusel, F Heinrich, W Kasper.
Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism.
N Engl J Med, 347 (2002), pp. 1143-1150
[11]
W Kasper, A Geibel, N Tiede, D Bassenge, E Kauder, S Konstantinides, et al.
Distinguishing between acute and subacute massive pulmonary embolism by convencional and Doppler echocardiography.
Br Heart J, 70 (1993), pp. 352-356
[12]
S Grifoni, I Olivotto, P Cecchini, F Pieralli, A Camaiti, G Santoro, et al.
Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction.
Circulation, 101 (2000), pp. 237-247
[13]
W Kasper, S Konstantinides, A Geibel, N Tiede, T Krause, H Just.
Prognostic significance of right ventricular afterload stress detected by echocardiography in patients with clinically suspected pulmonary embolism.
Heart, 77 (1997), pp. 346-349
[14]
A Ribeiro, P Lindmarker, A Juhlin-Dannfelt, H Johnsson, L Jorfeldt.
Echocardiography Doppler in pulmonary embolism; right ventricular dysfunction as a predictor of mortality rate.
Am Heart J, 134 (1997), pp. 479-487
[15]
M ten Wolde, M Sohne, E Quak, MR MacGillavry, HR Buller.
Prognostic value of echocardiographically assessed right ventricular dysfunction in patients with pulmonary embolism.
Arch Intern Med, 164 (2004), pp. 1685-1689
[16]
M Remy-Jardin, J Remy, L Wattinne, F Giraud.
Central pulmonary thromboembolism: diagnosis with spiral volumetric CT with the single-breath-hold-technique-comparison with pulmonary angiography.
Radiology, 185 (1992), pp. 381-387
[17]
PIOPED investigators.
Value of ventilation/perfusion scan in acute pulmonary embolism: results of the Prospective Investigation of the Pulmonary Embolism Diagnosis (PIOPED).
JAMA, 263 (1990), pp. 2753-2759
[18]
S Konstantinides, A Geibel, W Kasper, M Olschewski, L Blumel, H Just.
Patent foramen ovale is an important predictor of adverse outcome in patients with major pulmonary embolism.
Circulation, 97 (1998), pp. 1946-1951
[19]
SZ Goldhaber.
Thrombolytic therapy for patients with pulmonary embolism who are hemodynamically stable but have right ventricular dysfunction.
Arch Intern Med, 165 (2005), pp. 2197-2199
[20]
D Nauffal, R Otero, A Cayuela, D Jiménez, M Oribe, F Conget, et al.
Complicaciones precoces en pacientes con embolia de pulmón.
Med Clin (Barc), 127 (2006), pp. 1-4
[21]
S Grifoni, I Olivotto, P Cecchini, F Pieralli, A Camaiti, G Santoro, et al.
Utility of an integrated clinical, echocardiographic, and venous ultrasonographic approach for triage of patients with suspected pulmonary embolism.
Am J Cardiol, 65 (1998), pp. 101-109
[22]
S Konstantinides.
Pulmonary embolism: impact of right ventricular dysfunction.
Curr Opin Cardiol, 20 (2005), pp. 496-501
[23]
D Aujesky, DS Obrosky, RA Stone, TE Auble, A Perrier, J Cornuz, et al.
Derivation and validation of a prognostic model for pulmonary embolism.
Am J Respir Crit Care Med, 172 (2005), pp. 1041-1046
[24]
D Aujesky, PM Roy, CP Le Manach, F Verschuren, G Meyer, DS Obrosky, et al.
Validation of a model to predict adverse outcomes in patients with pulmonary embolism.
Eur Heart J, 27 (2006), pp. 476-481
[25]
N Kucher, E Rossi, M de Rosa, SZ Goldhaber.
Prognostic role of echocardiography among patients with acute pulmonary embolism and a systolic arterial pressure of 90 mm Hg or higher.
Arch Intern Med, 165 (2005), pp. 1777-1781
[26]
Task Force Report.
Guidelines on diagnosis and management of acute pulmonary embolism.
Eur Heart J, 21 (2000), pp. 1301-1336
[27]
RW Ashton, CE Daniels, JH Ryu.
Thrombolytic therapy in patients with submassive pulmonary embolism.
N Engl J Med, 348 (2003), pp. 357-359
[28]
NA Gunn, LM Tierney Jr.
Thrombolytic therapy in patients with submassive pulmonary embolism.
N Engl J Med, 348 (2003), pp. 357-359
[29]
G Thabut, D Logeart.
Thrombolysis for pulmonary embolism in patients with right ventricular dysfunction.
Arch Intern Med, 165 (2005), pp. 2200-2203
Copyright © 2007. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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