USE OF TRANSTHORACIC DOPPLER-ECHOCARDIOGRAPHY COMBINED WITH CLINICAL AND ELECTROCARDIOGRAPHIC DATA TO PREDICT ACUTE PULMONARY-EMBOLISM

Transthoracic echocardiography and continuous wave Doppler were prospe ctively performed in 132 out-patients with suspicion of pulmonary embo lism, and who had no previous history of severe cardiac or pulmonary d isease. Bedside echocardiography deter-mined diagnosis other than pulm onary embolism in 55 patients. Further study was completed in 70 patie nts; pulmonary embolism was found in 31 and excluded in 39. Significan t differences were found as regards right ventricular diameter (27 +/- 8 vs 22 +/- 5 mm, P < 0.001), left ventricular diameter (41 +/- 9 vs 49 +/- 7 mm, P < 0.001), right over left ventricular diameter ratio (0 .67 +/- 0.23 vs 0.43 +/- 0.15, P < 0.0001), tricuspid regurgitant flow peak velocity (2.9 +/- 0.4 vs 2.4 +/- 0.7 m. s(-1) P < 0.0001), and a bnormal septum motion (12 vs 4, P < 0.01). Multivariate analysis of ec hocardiographic data included a tricuspid regurgitant flow peak veloci ty greater than 2.5 m. s(-1) and a right over left ventricular diamete r ratio greater than 0.5 in a logistic model (sensitivity 93%, specifi city 81%). The combination of echocardiographic and non-echocardiograp hic data included the two previous echocardiographic variables, togeth er with signs of deep vein thrombosis, a deep S wave in lead D1, and a Q wave in lead D3 on the electrocardiogram in a logistic model (sensi tivity 96%, specificity 83%). It can be concluded that emergency echoc ardiography, alone or combined with clinical examination and electroca rdiogram, satisfactorily predicts acute pulmonary embolism.