Skip to main content
PMC home page
British Heart Journal logoLink to British Heart Journal
. 1993 Oct;70(4):352–356. doi: 10.1136/hrt.70.4.352

Distinguishing between acute and subacute massive pulmonary embolism by conventional and Doppler echocardiography.

W Kasper 1, A Geibel 1, N Tiede 1, D Bassenge 1, E Kauder 1, S Konstantinides 1, T Meinertz 1, H Just 1
PMCID: PMC1025331  PMID: 8217444

Abstract

OBJECTIVE--To determine the ability of conventional and Doppler echocardiography to distinguish between minor, acute massive, and subacute massive pulmonary embolism in patients with confirmed pulmonary embolism. DESIGN--Prospective study of a consecutive series of 47 patients with confirmed pulmonary embolism. SETTING--Department of internal medicine, university clinic. PATIENTS--11 patients (23%) had minor, 23 patients (49%) had acute massive, and 13 patients (28%) had subacute massive pulmonary embolism. RESULTS--Dilatation of the right ventricular cavity (33 (92%)) and asynergy of the right ventricular free wall (29 (81%)) were seen only in patients with acute and subacute massive pulmonary embolism (n = 36). 23 (64%) with pulmonary hypertension had tricuspid regurgitation. The velocity of the tricuspid regurgitant jet correlated with the pulmonary arterial pressure (r = 0.88, SEE = 11.6 mm Hg) and was significantly lower in patients with acute massive pulmonary embolism (3.0 (0.4) m/s, n = 12) than in patients with subacute massive pulmonary embolism (4.2 (0.6) m/s; n = 11) (p < 0.001). The use of predefined indices (right ventricular free wall thickness > 5 mm; tricuspid regurgitant jet velocity > 3.7 m/s; and the occurrence of both a dilated right ventricular cavity with normal interventricular septal motion, or an inspiratory collapse of the inferior vena cava, or both) correctly identified 11 of 13 patients (85%) with subacute massive pulmonary embolism. CONCLUSION--Conventional and Doppler echocardiography were successful in evaluating the haemodynamic consequences of pulmonary embolism.

Full text

PDF
352

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bochereau G., Scheuble C., Cereze P., Chauveau P., Jounitzky D., Kleinknecht D. Intérêt de l'échographie dans le diagnostic d'un coeur pulmonaire aigu. A propos de 6 observations. Agressologie. 1980;21(100):112–119. [PubMed] [Google Scholar]
  2. Castillo-Fenoy A., Scheuble C., Benacerraf A., Brau J., Cérèze P. Séméiologie échographique de l'embolie pulmonaire aiguë. Arch Mal Coeur Vaiss. 1980 Aug;73(8):971–978. [PubMed] [Google Scholar]
  3. Chapoutot L., Metz D., Jolly D., Laudinat J. M., Pollet E., Taupin J. M., Elaerts J., Bajolet A. Intérêt diagnostique, pronostique et thérapeutique de l'échocardiographie Doppler dans l'embolie pulmonaire. A propos de 41 cas. Ann Cardiol Angeiol (Paris) 1989 Nov;38(9):523–529. [PubMed] [Google Scholar]
  4. Come P. C., Kim D., Parker J. A., Goldhaber S. Z., Braunwald E., Markis J. E. Early reversal of right ventricular dysfunction in patients with acute pulmonary embolism after treatment with intravenous tissue plasminogen activator. J Am Coll Cardiol. 1987 Nov;10(5):971–978. doi: 10.1016/s0735-1097(87)80333-9. [DOI] [PubMed] [Google Scholar]
  5. Currie P. J., Seward J. B., Chan K. L., Fyfe D. A., Hagler D. J., Mair D. D., Reeder G. S., Nishimura R. A., Tajik A. J. Continuous wave Doppler determination of right ventricular pressure: a simultaneous Doppler-catheterization study in 127 patients. J Am Coll Cardiol. 1985 Oct;6(4):750–756. doi: 10.1016/s0735-1097(85)80477-0. [DOI] [PubMed] [Google Scholar]
  6. Foale R., Nihoyannopoulos P., McKenna W., Kleinebenne A., Nadazdin A., Rowland E., Smith G., Klienebenne A. Echocardiographic measurement of the normal adult right ventricle. Br Heart J. 1986 Jul;56(1):33–44. doi: 10.1136/hrt.56.1.33. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Jardin F., Dubourg O., Guéret P., Delorme G., Bourdarias J. P. Quantitative two-dimensional echocardiography in massive pulmonary embolism: emphasis on ventricular interdependence and leftward septal displacement. J Am Coll Cardiol. 1987 Dec;10(6):1201–1206. doi: 10.1016/s0735-1097(87)80119-5. [DOI] [PubMed] [Google Scholar]
  8. Kasper W., Geibel A., Tiede N., Hofmann T., Meinertz T., Just H. Die Echokardiographie in der Diagnostik der Lungenembolie. Herz. 1989 Apr;14(2):82–101. [PubMed] [Google Scholar]
  9. Kasper W., Meinertz T., Henkel B., Eissner D., Hahn K., Hofmann T., Zeiher A., Just H. Echocardiographic findings in patients with proved pulmonary embolism. Am Heart J. 1986 Dec;112(6):1284–1290. doi: 10.1016/0002-8703(86)90361-3. [DOI] [PubMed] [Google Scholar]
  10. Kasper W., Meinertz T., Kersting F., Löllgen H., Just H. Wall motion characteristic of the right pulmonary artery in the suprasternal echocardiogram. J Clin Ultrasound. 1980 Jun;8(3):201–206. doi: 10.1002/jcu.1870080303. [DOI] [PubMed] [Google Scholar]
  11. Kasper W., Meinertz T., Kersting F., Löllgen H., Limbourg P., Just H. Echocardiography in assessing acute pulmonary hypertension due to pulmonary embolism. Am J Cardiol. 1980 Mar;45(3):567–572. doi: 10.1016/s0002-9149(80)80006-3. [DOI] [PubMed] [Google Scholar]
  12. Massie B. M., Schiller N. B., Ratshin R. A., Parmley W. W. Mitral-septal separation: new echocardiographic index of left ventricular function. Am J Cardiol. 1977 Jun;39(7):1008–1016. doi: 10.1016/s0002-9149(77)80215-4. [DOI] [PubMed] [Google Scholar]
  13. Matsukubo H., Matsuura T., Endo N., Asayama J., Watanabe T. Echocardiographic measurement of right ventricular wall thickness. A new application of subxiphoid echocardiography. Circulation. 1977 Aug;56(2):278–284. doi: 10.1161/01.cir.56.2.278. [DOI] [PubMed] [Google Scholar]
  14. McIntyre K. M., Sasahara A. A. Hemodynamic and ventricular responses to pulmonary embolism. Prog Cardiovasc Dis. 1974 Nov-Dec;17(3):175–190. doi: 10.1016/0033-0620(74)90042-5. [DOI] [PubMed] [Google Scholar]
  15. Metz D., Chapoutot L., Pollet E., Jolly D., Chabert J. P., Elaerts J., Bajolet A. Intérêt diagnostique et pronostique du Doppler continu dans l'embolie pulmonaire. Arch Mal Coeur Vaiss. 1988 Sep;81(9):1087–1091. [PubMed] [Google Scholar]
  16. Miller G. A., Sutton G. C. Acute massive pulmonary embolism. Clinical and haemodynamic findings in 23 patients studied by cardiac catheterization and pulmonary arteriography. Br Heart J. 1970 Jul;32(4):518–523. doi: 10.1136/hrt.32.4.518. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Moreno F. L., Hagan A. D., Holmen J. R., Pryor T. A., Strickland R. D., Castle C. H. Evaluation of size and dynamics of the inferior vena cava as an index of right-sided cardiac function. Am J Cardiol. 1984 Feb 1;53(4):579–585. doi: 10.1016/0002-9149(84)90034-1. [DOI] [PubMed] [Google Scholar]
  18. Simonson J. S., Schiller N. B. Sonospirometry: a new method for noninvasive estimation of mean right atrial pressure based on two-dimensional echographic measurements of the inferior vena cava during measured inspiration. J Am Coll Cardiol. 1988 Mar;11(3):557–564. doi: 10.1016/0735-1097(88)91531-8. [DOI] [PubMed] [Google Scholar]
  19. Skjaerpe T., Hatle L. Noninvasive estimation of systolic pressure in the right ventricle in patients with tricuspid regurgitation. Eur Heart J. 1986 Aug;7(8):704–710. doi: 10.1093/oxfordjournals.eurheartj.a062126. [DOI] [PubMed] [Google Scholar]
  20. Sutton G. C., Hall R. J., Kerr I. H. Clinical course and late prognosis of treated subacute massive, acute minor, and chronic pulmonary thromboembolism. Br Heart J. 1977 Oct;39(10):1135–1142. doi: 10.1136/hrt.39.10.1135. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Tiede N., Kasper W., Geibel A., Bassenge D., Langenstein B., Meinertz T., Just H. Thrombolytische Behandlung der akuten und subakuten rezidivierenden Lungenembolie mit rekombinantem Gewebe-Plasminogenaktivator. Dtsch Med Wochenschr. 1990 Nov 9;115(45):1699–1704. doi: 10.1055/s-2008-1065213. [DOI] [PubMed] [Google Scholar]
  22. Yock P. G., Popp R. L. Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation. 1984 Oct;70(4):657–662. doi: 10.1161/01.cir.70.4.657. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES