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- Title
Echocardiographic Diagnosis of Acute Pulmonary Embolism in Patients with McConnell's Sign.
- Authors
Mediratta, Anuj; Addetia, Karima; Medvedofsky, Diego; Gomberg‐Maitland, Mardi; Mor‐Avi, Victor; Lang, Roberto M.
- Abstract
Background 'McConnell's sign' (Mc CS), described as hypo- or akinesis of the right ventricular ( RV) free wall with preservation of the apex, is associated with acute pulmonary embolism ( aPE). However, the sensitivity of Mc CS for the detection of aPE is limited. We sought to evaluate in patients with Mc CS, whether echocardiographic parameters of global and regional RV function could differentiate between patients with and without aPE. Methods We reviewed echocardiograms of 81 patients with Mc CS, who underwent CT or V/Q studies for suspected PE, and 40 normal controls ( NL). Echocardiograms were analyzed to measure pulmonary artery systolic pressure ( PASP), tricuspid regurgitation ( TR) by vena contracta width, conventional indices of RV function, and speckle tracking-derived longitudinal free wall strain. ROC analysis was performed to evaluate the diagnostic accuracy of these parameters for diagnosis of aPE. Results Fifty-five of eighty-one (68%) had PE (Mc CS + PE), while 26 of 81 (32%) did not (Mc CS − PE). Compared to NL, global and segmental RV strain were lower in patients with Mc CS, contrary to the notion of normal apical function. In Mc CS + PE, compared to Mc CS − PE: (1) PASP, fractional area change and TR were significantly lower; (2) strain magnitude was significantly lower globally and in basal and apical segments. Individual parameters had similar diagnostic accuracy by ROC analysis, which further improved by combining parameters. In Mc CS − PE, 69% of patients had pulmonary hypertension ( PH). Conclusions Mc CS and aPE are not synonymous. RV free wall strain may aid in differential diagnosis of patients with Mc CS evaluated for aPE. Specifically, Mc CS should prompt an inquiry for evidence of PH, which would indicate that aPE is less likely.
- Subjects
PULMONARY embolism; ECHOCARDIOGRAPHY; HYPOKINESIA; CONTINUING education units; CONTROL groups; RETROSPECTIVE studies; RECEIVER operating characteristic curves; DATA analysis software; DESCRIPTIVE statistics; DIAGNOSIS
- Publication
Echocardiography, 2016, Vol 33, Issue 5, p696
- ISSN
0742-2822
- Publication type
Article
- DOI
10.1111/echo.13142