Acil serviste pulmoner emboli öntanısı ile tetkik edilen hastalarda ekokardiyografi bulgularının tanısal değerliliğinin retrospektif kesitsel analizi
Küçük Resim Yok
Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Objective:
In patients who were examined in the emergency department with the suspicion of pulmonary embolism, Early Systolic Notching finding was evaluated together with other echocardiographic findings, to make an earlier diagnosis, to make a quicker treatment decision, and to reduce mortality.
Material and Method
In the prospective and methodologically designed study, echocardiographic data of the patients were obtained prospectively, while laboratory results were obtained retrospectively at the end of the study. In the study, patients who applied to the Ege University Medical Faculty Emergency Department between 29 May 2020 and 29 May 2021 and who underwent computed tomography with the presumptive diagnosis of pulmonary embolism by their primary physician were evaluated. Regardless of the results, the patients underwent echocardiography and were recorded in the study form. At the end of the study period, the laboratory results of the patients were scanned and recorded in the same study form.
Results:
A total of 282 patients who underwent computed tomography with a prediagnosis of pulmonary thromboembolism by their primary physician were included in the study. Pulmonary thromboembolism was diagnosed in 46.5% of the patients. 75.5% of patients diagnosed with pulmonary thromboembolism were hospitalized or referred to another health institution. While the 90-day mortality rate due to all causes was determined as 8.5%, the 90-day mortality rate of the patients diagnosed with pulmonary thromboembolism was 12.2%.
Echocardiographic examination was performed in all of the patients, regardless of the computed tomography results. When the echocardiographic results of patients diagnosed with pulmonary thromboembolism are examined, the most common findings are respectively; right structures dilatation (26%), 60/60 Sign (13%), Early Systolic Notching Sign (10.7%), McConnell Sign (8.4%), TAPSE sign (7.6%), and movement in right heart structures thrombus was present (2.3%). When the demographic data of the patients were examined; Age, gender and comorbid diseases did not show a statistically significant relationship with the diagnosis of pulmonary thromboembolism. When the risk factors of the patients in terms of pulmonary thromboembolism were examined; Pulmonary thromboembolism risk was found to be statistically high (p<0.001) in patients with 1 or more of the following risk factors: immobility, hemoptysis, deep vein thrombosis, previous major surgery, history of trauma, travel history, malignancy. In addition, in our study, it was observed that the patients were diagnosed with pulmonary thromboembolism more frequently as the calculated WELLS score risk increased (p<0.001).
Considering the anatomical location of the embolism in patients diagnosed with pulmonary thromboembolism, subsegmental embolism (6.8%), segmental embolism (40.5%), and lobar embolism (52.7%) were observed.
Considering the sensitivity and specificity of echocardiographic findings in the diagnosis of pulmonary thromboembolism, in order; 12.3% - 99.3% for early systolic notching, 26.7% - 98% for right structures dilatation, 13.4% - 100% for 60/60 sign, and 9% - 100% for McConnell sign.
Early Systolic Notching could be evaluated in 256 (90.8%) of 282 patients due to their echocardiographic features. Early Systolic Notching was positive in 15 patients (5.3%). Pulmonary thromboembolism was detected in 14 of these patients (93.3%), and 10 patients (66.6%) received thrombolytic treatment. Early Systolic Notching sign; The presence of pulmonary thromboembolism (p<0.001), patient outcome (p=0.003) and the choice of treatment (p<0.001) were found to be significantly related. There was no significant relationship with mortality.
The 60/60 Sign could be evaluated in 268 (95%) of 282 patients due to their echocardiographic features. The 60/60 sign was positive in 17 patients (6%) and all of these patients were diagnosed with pulmonary thromboembolism. 60/60 Finding; It was found that there was a significant correlation with the presence of pulmonary thromboembolism (p<0.001), embolism type (p<0.001), treatment choice (p<0.001) and patient outcome (p=0.005). There was no significant relationship with mortality.
McConnell Sign could be evaluated in 276 (97.9%) of 282 patients due to their echocardiographic features. McConnell Sign was positive in 11 patients (3.9%), and all of these patients were hospitalized with the diagnosis of pulmonary thromboembolism. McConnell Sign; The presence of pulmonary thromboembolism (p<0.001), embolism type (p<0.001), patient outcome (p=0.005) and the choice of treatment to be given (p<0.001) were found to be significantly related. There was no significant relationship with mortality.
When the presence of mobile thrombus in the right structures and TAPSE finding were evaluated alone; There was no significant relationship between the presence of pulmonary thromboembolism, patient outcome, choice of treatment to be given, and mortality.
Conclusion
In addition to supporting the diagnosis, echocardiographic findings are also useful in predicting the diagnosis, the choice of treatment to be given and the outcome of the patients who are examined with the presumptive diagnosis of pulmonary thromboembolism. With these features, it is possible for patients to reach diagnosis and treatment earlier as a result of the echocardiographic examination to be performed by an experienced practitioner. Due to early diagnosis and treatment practices, mortality and morbidity rates can be reduced.
Açıklama
Anahtar Kelimeler
Erken Sistolik Çentiklenme, Pulmoner Tromboemboli, Ekokardiyografi, Trombolitik Tedavi, Early Systolic Notching, Pulmonary Thromboembolism, Echocardiography, Thrombolytic Therapy
