Is Doppler-echocardiography useful in the diagnostic work-up of pulmonary embolism?

n° 1180-46 / Is Doppler-Echocardiography Useful in the Diagnostic Work-Up of Pulmonary Embolism? Lorenza Pratali, Massimo Miniati, Simonetta Monti, Maria de Lorenzo, Giorgio Di Ricco, Bruno Formichi, Carlo Marini, Renato Prediletto, Massimo Pistolesi. CNR institute of Clinical Physiology, Piss, /ta/y Background: To assess the value of Doppler-echocardiography in the diag- nosis of pulmonary embolism (PE), we evaluated 110 consecutive patients with suspected PE (mean age 63.6 f 17.3 yr; inpatients 72%) who were en- rolled in the Prospective Investigative Study of Acute Pulmonary Embolism Diagnosis (PISA-PED). Methods: Prior to perfusion lung scanning, patients were examined in- dependently by six pulmonologists; clinical probability of PE was rated as low (lo%), intermediate (50%), or high (90%) according to a standardized diagnostic algorithm. Pulmonary angiography was required in patients with abnormal perfusion scans. In all patients, a 2-D echocardiographic study was performed by a cardiologist who was blind to clinical and lung scan data. The coexistence of right ventricular dilatation (end-diastolic diameter > 27 mm) and tricuspid regurgitation velocity > 2.7 m/s was used as a criterion to diagnose PE by echocardiography, Bayes' theorem was applied to calculate the probability of PE conditioned by echocardiographic results (post-test probability) as a function of the clinical probability of PE (pretest probability). Results: PE was diagnosed by pulmonary angiography in 43 (39%) of 110 patients. Both right ventricular dilatation and tricuspid regurgitation ve- locity > 2.7 m/s were present in 23 (53%) of 43 patients with confirmed PE and in 7 (10%) of 67 without PE (sensitivity 53%, specificity 90%). Among patients with PE, those who were correctly classified as having PE by echo- cardiography had a significantly higher number of unperfused lung segments on the lung scan (8.8 i 2.4) than those who were misclassified as not having PE (5.9 f 2.3, p =Z 0.001). For pretest (clinical) probabilities of 10, 50, and 90%, the post-test probabilities of PE conditioned by echocardiographic find- ings compatible with PE were 37, 84, and 99%, respectively; the post-test probabilities of PE conditioned by echocardiographic findings not compatible with PE were 5, 34, and 82%: respectively.