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Lyhne MD, Bikdeli B, Dudzinski DM, Muriel-García A, Kabrhel C, Sancho-Bueso T, Pérez-David E, Lobo JL, Alonso-Gómez Á, Jiménez D, Monreal M. Validation of Echocardiographic Measurements in Patients with Pulmonary Embolism in the RIETE Registry. TH OPEN 2024; 8:e1-e8. [PMID: 38197015 PMCID: PMC10774011 DOI: 10.1055/s-0043-1777765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/01/2023] [Indexed: 01/11/2024] Open
Abstract
Background In acute pulmonary embolism (PE), echocardiographic identification of right ventricular (RV) dysfunction will inform prognostication and clinical decision-making. Registro Informatizado Enfermedad TromboEmbolica (RIETE) is the world's largest registry of patients with objectively confirmed PE. The reliability of site-reported RV echocardiographic measurements is unknown. We aimed to validate site-reported key RV echocardiographic measurements in the RIETE registry. Methods Fifty-one randomly chosen patients in RIETE who had transthoracic echocardiogram (TTE) performed for acute PE were included. TTEs were de-identified and analyzed by a core laboratory of two independent observers blinded to site-reported data. To investigate reliability, intraclass correlation coefficients (ICCs) and Bland-Altman plots between the two observers, and between an average of the two observers and the RIETE site-reported data were obtained. Results Core laboratory interobserver variations were very limited with correlation coefficients >0.8 for all TTE parameters. Agreement was substantial between core laboratory observers and site-reported data for key parameters including tricuspid annular plane systolic excursion (ICC 0.728; 95% confidence interval [CI], 0.594-0.862) and pulmonary arterial systolic pressure (ICC 0.726; 95% CI, 0.601-0.852). Agreement on right-to-left ventricular diameter ratio (ICC 0.739; 95% CI, 0.443-1.000) was validated, although missing data limited the precision of the estimates. Bland-Altman plots showed differences close to zero. Conclusion We showed substantial reliability of key RV site-reported measurements in the RIETE registry. Ascertaining the validity of such data adds confidence and reliability for subsequent investigations.
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Affiliation(s)
- Mads Dam Lyhne
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Behnood Bikdeli
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Yale-New Haven Hospital (YNHH)/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States
| | - David M. Dudzinski
- Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Alfonso Muriel-García
- Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal, Madrid and CIBERESP, Universidad de Alcalá, Madrid, Spain
| | - Christopher Kabrhel
- Department of Emergency Medicine, Centre of Vascular Emergencies, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Teresa Sancho-Bueso
- Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
| | | | - José Luis Lobo
- Department of Pneumonology, Hospital Universitario Araba, Álava, Spain
| | | | - David Jiménez
- Respiratory Department, Hospital Ramón y Cajal and Medicine Department, Universidad de Alcalá, Madrid, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Manuel Monreal
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Murcia, Spain
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Lashin H, Olusanya O, Smith A, Bhattacharyya S. Right ventricular echocardiographic parameters and prediction of stroke volume in ischemic cardiogenic shock: A retrospective study. J Crit Care 2023; 74:154219. [PMID: 36494258 DOI: 10.1016/j.jcrc.2022.154219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE This study investigated which commonly used right ventricular (RV) echocardiographic parameter correlates best with stroke volume (SV) estimated by Doppler echocardiography in ischemic cardiogenic shock (CS). MATERIALS AND METHODS We retrospectively reviewed the records of 100 patients admitted to the ICU over 34 months with CS. Tricuspid annular plane systolic excursion (TAPSE), Tricuspid annulus systolic velocity (RV S'), Tricuspid regurgitation maximum velocity (TR Vmax), and RV outflow tract velocity time integral (RVOT VTI) were correlated to SV. RESULTS Mean age was 62.6 ± 12.7 years and 78% were male. The mean SV, TAPSE, RV S', TR Vmax, and RVOT VTI were 47 ± 16 ml, 16 ± 5 mm, 11 ± 4 mm/s, 1.97 ± 0.73 m/s, and 12.7 ± 5 cm, respectively. RVOT VTI correlated best to SV (r = 0.39 p = 0.01) compared to TAPSE, RV S', and TR Vmax (r = 0.26 p = 0.01, r = 0.15 p = 0.21, r = 0.03 p = 0.78). RVOT VTI independently predicted SV. Univariate analysis demonstrated that only RVOT VTI predicted SV (OD = 1.18 p = 0.04) and had the best area under the curve (0.70, p = 0.03). CONCLUSION RVOT VTI correlated better (albeit weakly) to and best predicted SV compared to TAPSE, RV S', and TR Vmax in patients admitted to intensive care with CS. This study suggests that RVOT VTI has the potential as a therapeutic target to optimize SV in CS.
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Affiliation(s)
- Hazem Lashin
- Adult Critical Care Unit, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK; William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, UK.
| | - Olusegun Olusanya
- Adult Critical Care Unit, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Andrew Smith
- Adult Critical Care Unit, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK; William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, UK
| | - Sanjeev Bhattacharyya
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, UK; Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
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Prada G, Pustavoitau A, Koenig S, Mitchell C, Stainback RF, Díaz-Gómez JL. Focused Cardiac Ultrasonography for Right Ventricular Size and Systolic Function. N Engl J Med 2022; 387:e52. [PMID: 36416769 DOI: 10.1056/nejmvcm2004089] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Gabriel Prada
- From Johns Hopkins Hospital, Baltimore (G.P., A.P.); Albert Einstein College of Medicine, New York (S.K.); the University of Wisconsin, Madison (C.M.); and Baylor College of Medicine, Houston (R.F.S., J.L.D.-G.)
| | - Aliaksei Pustavoitau
- From Johns Hopkins Hospital, Baltimore (G.P., A.P.); Albert Einstein College of Medicine, New York (S.K.); the University of Wisconsin, Madison (C.M.); and Baylor College of Medicine, Houston (R.F.S., J.L.D.-G.)
| | - Seth Koenig
- From Johns Hopkins Hospital, Baltimore (G.P., A.P.); Albert Einstein College of Medicine, New York (S.K.); the University of Wisconsin, Madison (C.M.); and Baylor College of Medicine, Houston (R.F.S., J.L.D.-G.)
| | - Carol Mitchell
- From Johns Hopkins Hospital, Baltimore (G.P., A.P.); Albert Einstein College of Medicine, New York (S.K.); the University of Wisconsin, Madison (C.M.); and Baylor College of Medicine, Houston (R.F.S., J.L.D.-G.)
| | - Raymond F Stainback
- From Johns Hopkins Hospital, Baltimore (G.P., A.P.); Albert Einstein College of Medicine, New York (S.K.); the University of Wisconsin, Madison (C.M.); and Baylor College of Medicine, Houston (R.F.S., J.L.D.-G.)
| | - José L Díaz-Gómez
- From Johns Hopkins Hospital, Baltimore (G.P., A.P.); Albert Einstein College of Medicine, New York (S.K.); the University of Wisconsin, Madison (C.M.); and Baylor College of Medicine, Houston (R.F.S., J.L.D.-G.)
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Tucker RV, Williams K, Theyyunni N, Fung CM. Sepsis-Induced Cardiomyopathy Detected With Focused Cardiac Ultrasound in the Emergency Department. J Emerg Med 2022; 63:e91-e99. [DOI: 10.1016/j.jemermed.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/04/2022] [Accepted: 06/04/2022] [Indexed: 12/05/2022]
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Weekes AJ, Raper JD, Thomas AM, Lupez K, Cox CA, Esener D, Boyd JS, Nomura JT, Davison J, Ockerse PM, Leech S, Abrams E, Kelly C, O'Connell NS. Electrocardiographic findings associated with early clinical deterioration in acute pulmonary embolism. Acad Emerg Med 2022; 29:1185-1196. [PMID: 35748352 PMCID: PMC9796434 DOI: 10.1111/acem.14554] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES We sought to determine associations of early electrocardiogram (ECG) patterns with clinical deterioration (CD) within 5 days and with RV abnormality (abnlRV) by echocardiography in pulmonary embolism (PE). METHODS In this prospective, multicenter study of newly confirmed PE patients, early echocardiography and initial ECG were examined. Initial ECG patterns included lead-specific ST-segment elevation (STE) or depression (STD), T-wave inversion (TWI), supraventricular tachycardia (SVT), sinus tachycardia, and right bundle branch block as complete (cRBBB) or incomplete (iRBBB). We defined CD as respiratory failure, hypotension, dysrhythmia, cardiac arrest, escalated PE intervention, or death within 5 days. We calculated odds ratios (ORs) for CD and abnlRV with univariate and full multivariate models in the presence of other variables. RESULTS Of 1676 patients, 1629 (97.2%) had both ECG and GDE; 415/1676 (24.7%) had CD, and 529/1629 (32.4%) had abnlRV. AbnlRV had an OR for CD of 4.25 (3.35, 5.38). By univariable analysis, the absence of abnormal ECG patterns had OR for CD and abnlRV of 0.34 (0.26, 0.44; p < 0.001) and 0.24 (0.18, 0.31; p < 0.001), respectively. By multivariable analyses, one ECG pattern had a significant OR for CD: SVT 2.87 (1.66, 5.00). Significant ORS for abnlRV were: TWI V2-4 4.0 (2.64, 6.12), iRBBB 2.63 (1.59, 4.38), STE aVR 2.42 (1.58, 3.74), S1-Q3-T3 2.42 (1.70, 3.47), and sinus tachycardia 1.68 (1.14, 2.49). CONCLUSIONS SVT was an independent predictor of CD. TWI V2-4 , iRBBB, STE aVR, sinus tachycardia, and S1-Q3-T3 were independent predictors of abnlRV. Finding one or more of these ECG patterns may increase considerations for performance of echocardiography to look for RV abnormalities and, if present, inform concerns for early clinical deterioration.
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Affiliation(s)
- Anthony J. Weekes
- Department of Emergency MedicineAtrium Health's Carolinas Medical Center (Carolinas Medical Center is the Central Site of the Pulmonary Embolism Short‐term Outcomes Registry (PESCOR) consortium)CharlotteNorth CarolinaUSA
| | - Jaron D. Raper
- Department of Emergency MedicineAtrium Health's Carolinas Medical Center (Carolinas Medical Center is the Central Site of the Pulmonary Embolism Short‐term Outcomes Registry (PESCOR) consortium)CharlotteNorth CarolinaUSA,Jaron D. Raper, Department of Emergency MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Alyssa M. Thomas
- Department of Emergency MedicineAtrium Health's Carolinas Medical Center (Carolinas Medical Center is the Central Site of the Pulmonary Embolism Short‐term Outcomes Registry (PESCOR) consortium)CharlotteNorth CarolinaUSA,Alyssa M. Thomas, Emergency DepartmentHouston Methodist Baytown HospitalHoustonTexasUSA
| | - Kathryn Lupez
- Department of Emergency MedicineAtrium Health's Carolinas Medical Center (Carolinas Medical Center is the Central Site of the Pulmonary Embolism Short‐term Outcomes Registry (PESCOR) consortium)CharlotteNorth CarolinaUSA,Kathryn Lupez, Department of Emergency MedicineTufts Medical CenterBostonMassachusettsUSA
| | - Carly A. Cox
- Department of Emergency MedicineAtrium Health's Carolinas Medical Center (Carolinas Medical Center is the Central Site of the Pulmonary Embolism Short‐term Outcomes Registry (PESCOR) consortium)CharlotteNorth CarolinaUSA,Carly A. Cox, Emergency Medicine of IdahoMeridianIdahoUSA
| | - Dasia Esener
- Department of Emergency Medicine Kaiser PermanenteSan DiegoCaliforniaUSA
| | - Jeremy S. Boyd
- Department of Emergency MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Jason T. Nomura
- Department of Emergency MedicineChristiana CareNewarkDelawareUSA
| | - Jillian Davison
- Department of Emergency MedicineOrlando HealthOrlandoFloridaUSA
| | - Patrick M. Ockerse
- Division of Emergency MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Stephen Leech
- Department of Emergency MedicineOrlando HealthOrlandoFloridaUSA
| | - Eric Abrams
- Department of Emergency Medicine Kaiser PermanenteSan DiegoCaliforniaUSA
| | - Christopher Kelly
- Division of Emergency MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Nathaniel S. O'Connell
- Department of Biostatistics and Data ScienceWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
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Impact of Deliberate Practice on Point-of-Care Ultrasound Interpretation of Right Ventricle Pathology. ATS Sch 2022; 3:229-241. [PMID: 35924202 PMCID: PMC9341488 DOI: 10.34197/ats-scholar.2021-0080oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/14/2021] [Indexed: 11/18/2022] Open
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Weekes AJ, Raper JD, Lupez K, Thomas AM, Cox CA, Esener D, Boyd JS, Nomura JT, Davison J, Ockerse PM, Leech S, Johnson J, Abrams E, Murphy K, Kelly C, Norton HJ. Development and validation of a prognostic tool: Pulmonary embolism short-term clinical outcomes risk estimation (PE-SCORE). PLoS One 2021; 16:e0260036. [PMID: 34793539 PMCID: PMC8601564 DOI: 10.1371/journal.pone.0260036] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/29/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Develop and validate a prognostic model for clinical deterioration or death within days of pulmonary embolism (PE) diagnosis using point-of-care criteria. METHODS We used prospective registry data from six emergency departments. The primary composite outcome was death or deterioration (respiratory failure, cardiac arrest, new dysrhythmia, sustained hypotension, and rescue reperfusion intervention) within 5 days. Candidate predictors included laboratory and imaging right ventricle (RV) assessments. The prognostic model was developed from 935 PE patients. Univariable analysis of 138 candidate variables was followed by penalized and standard logistic regression on 26 retained variables, and then tested with a validation database (N = 801). RESULTS Logistic regression yielded a nine-variable model, then simplified to a nine-point tool (PE-SCORE): one point each for abnormal RV by echocardiography, abnormal RV by computed tomography, systolic blood pressure < 100 mmHg, dysrhythmia, suspected/confirmed systemic infection, syncope, medico-social admission reason, abnormal heart rate, and two points for creatinine greater than 2.0 mg/dL. In the development database, 22.4% had the primary outcome. Prognostic accuracy of logistic regression model versus PE-SCORE model: 0.83 (0.80, 0.86) vs. 0.78 (0.75, 0.82) using area under the curve (AUC) and 0.61 (0.57, 0.64) vs. 0.50 (0.39, 0.60) using precision-recall curve (AUCpr). In the validation database, 26.6% had the primary outcome. PE-SCORE had AUC 0.77 (0.73, 0.81) and AUCpr 0.63 (0.43, 0.81). As points increased, outcome proportions increased: a score of zero had 2% outcome, whereas scores of six and above had ≥ 69.6% outcomes. In the validation dataset, PE-SCORE zero had 8% outcome [no deaths], whereas all patients with PE-SCORE of six and above had the primary outcome. CONCLUSIONS PE-SCORE model identifies PE patients at low- and high-risk for deterioration and may help guide decisions about early outpatient management versus need for hospital-based monitoring.
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Affiliation(s)
- Anthony J. Weekes
- Department of Emergency Medicine, Atrium Health’s Carolinas Medical Center, Charlotte, NC, United States of America
| | - Jaron D. Raper
- Department of Emergency Medicine, Atrium Health’s Carolinas Medical Center, Charlotte, NC, United States of America
| | - Kathryn Lupez
- Department of Emergency Medicine, Atrium Health’s Carolinas Medical Center, Charlotte, NC, United States of America
| | - Alyssa M. Thomas
- Department of Emergency Medicine, Atrium Health’s Carolinas Medical Center, Charlotte, NC, United States of America
| | - Carly A. Cox
- Department of Emergency Medicine, Atrium Health’s Carolinas Medical Center, Charlotte, NC, United States of America
| | - Dasia Esener
- Department of Emergency Medicine, Kaiser Permanente, San Diego, CA, United States of America
| | - Jeremy S. Boyd
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Jason T. Nomura
- Department of Emergency Medicine, Christiana Care, Newark, DE, United States of America
| | - Jillian Davison
- Department of Emergency Medicine, Orlando Health, Orlando, FL, United States of America
| | - Patrick M. Ockerse
- Division of Emergency Medicine, University of Utah Health, Salt Lake City, UT, United States of America
| | - Stephen Leech
- Department of Emergency Medicine, Orlando Health, Orlando, FL, United States of America
| | - Jakea Johnson
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Eric Abrams
- Department of Emergency Medicine, Kaiser Permanente, San Diego, CA, United States of America
| | - Kathleen Murphy
- Department of Emergency Medicine, Christiana Care, Newark, DE, United States of America
| | - Christopher Kelly
- Division of Emergency Medicine, University of Utah Health, Salt Lake City, UT, United States of America
| | - H. James Norton
- Professor Emeritus of Biostatistics, Atrium Health’s Carolinas Medical Center, Charlotte, NC, United States of America
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8
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Altersberger M, Schneider M, Schiller M, Binder-Rodriguez C, Genger M, Khafaga M, Binder T, Prosch H. Point of care echocardiography and lung ultrasound in critically ill patients with COVID-19. Wien Klin Wochenschr 2021; 133:1298-1309. [PMID: 34714384 PMCID: PMC8553894 DOI: 10.1007/s00508-021-01968-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 08/25/2021] [Indexed: 01/08/2023]
Abstract
Hundreds of millions got infected, and millions have died worldwide and still the number of cases is rising. Chest radiographs and computed tomography (CT) are useful for imaging the lung but their use in infectious diseases is limited due to hygiene and availability. Lung ultrasound has been shown to be useful in the context of the pandemic, providing clinicians with valuable insights and helping identify complications such as pleural effusion in heart failure or bacterial superinfections. Moreover, lung ultrasound is useful for identifying possible complications of procedures, in particular, pneumothorax. Associations between coronavirus disease 2019 (COVID-19) and cardiac complications, such as acute myocardial infarction and myocarditis, have been reported. As such, point of care echocardiography as well as a comprehensive approach in later stages of the disease provide important information for optimally diagnosing and treating complications of COVID-19. In our experience, lung ultrasound in combination with echocardiography, has a great impact on treatment decisions. In the acute state as well as in the follow-up setting after a severe or critical state of COVID-19, ultrasound can be of great impact to monitor the progression and regression of disease.
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Affiliation(s)
- Martin Altersberger
- Rehabilitation Center Hochegg for Cardiovascular and Respiratory Diseases, Friedrich Hillegeist Straße 2, 2840, Grimmenstein, Austria.,Department of Cardiology, Nephrology and Intensive Care Medicine, State Hospital Steyr, Steyr, Austria
| | - Matthias Schneider
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria, Waehringer Guertel 18-20, 1090
| | - Martina Schiller
- Department of Radiology, State hospital Neunkirchen, Neunkirchen, Austria
| | - Christina Binder-Rodriguez
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria, Waehringer Guertel 18-20, 1090
| | - Martin Genger
- Department of Cardiology, Nephrology and Intensive Care Medicine, State Hospital Steyr, Steyr, Austria
| | - Mounir Khafaga
- Rehabilitation Center Hochegg for Cardiovascular and Respiratory Diseases, Friedrich Hillegeist Straße 2, 2840, Grimmenstein, Austria
| | - Thomas Binder
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria, Waehringer Guertel 18-20, 1090.
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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Kameda T, Kimura A. Basic point-of-care ultrasound framework based on the airway, breathing, and circulation approach for the initial management of shock and dyspnea. Acute Med Surg 2020; 7:e481. [PMID: 31988793 PMCID: PMC6971464 DOI: 10.1002/ams2.481] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 01/06/2023] Open
Abstract
Ultrasound (US) carried out and interpreted by clinicians at the bedside is now called point‐of‐care US (POCUS). Clinical studies on POCUS have been carried out based on the ideas of “creation”, “extraction”, and “combination”. “Creation” refers to findings for the upper airway and lung being obtained at the bedside. “Extraction” refers to findings suitable for POCUS being extracted from comprehensive US, including echocardiography, abdominal US, and whole‐leg US. “Combination” refers to these POCUS applications being combined for the comprehensive assessment of patients with trauma, shock, or dyspnea. Emergency and critical care physicians have many opportunities to encounter trauma or non‐trauma patients with shock, dyspnea, or both. Furthermore, the scope of POCUS includes many diseases and injuries that present with both shock and dyspnea. Therefore, we propose a basic POCUS framework based on the systematic airway, breathing, and circulation approach for the initial management of shock and dyspnea in adult patients. In this article, we update and review each application of POCUS and their combination in this framework. Furthermore, we propose the practical usage of the framework based on clinical presentations to improve the management of shock and dyspnea.
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Affiliation(s)
- Toru Kameda
- Department of Emergency Medicine Red Cross Society Azumino Hospital Nagano Japan
| | - Akio Kimura
- Department of Emergency and Critical Care Center Hospital of the National Center for Global Health and Medicine Tokyo Japan
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Spies C, Metze M, Stöbe S, Hagendorff A. [Echocardiographic emergency diagnostics]. Herz 2019; 44:267-286. [PMID: 31020335 DOI: 10.1007/s00059-019-4799-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Echocardiography is a non-invasive, versatile imaging modality for the diagnostics and monitoring of life-threatening cardiac diseases. This article summarizes the currently valid recommendations on emergency echocardiography of the German Cardiac Society and the European Association of Cardiovascular Imaging and provides practical guidance for their implementation in emergency medicine. Echocardiography is especially important for the diagnostics of acute coronary syndrome and its potential complications, of pulmonary embolism and endocarditis as well as the differential diagnosis of patients in shock and in emergencies. A domain of increasing importance in echocardiography is the treatment monitoring of patients supported by modern cardiac assist devices.
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Affiliation(s)
- C Spies
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - M Metze
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - S Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - A Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland.
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Dabbouseh NM, Patel JJ, Bergl PA. Role of echocardiography in managing acute pulmonary embolism. Heart 2019; 105:1785-1792. [DOI: 10.1136/heartjnl-2019-314776] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/06/2019] [Accepted: 07/22/2019] [Indexed: 12/29/2022] Open
Abstract
The role of echocardiography in acute pulmonary embolism (PE) remains incompletely defined. Echocardiography cannot reliably diagnose acute PE, and it does not improve prognostication of patients with low-risk acute PE who lack other clinical features of right ventricular (RV) dysfunction. Echocardiography, however, may yield additional prognostic information in higher risk patients and can aid in distinguishing acute from chronic RV dysfunction. Specific echocardiographic markers of RV dysfunction have the potential to enhance prognostication beyond existing risk models. Until these markers are subjected to rigorous prospective studies, the therapeutic utility and economic value of echocardiography in acute PE are uncertain.
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13
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Dutta T, Aronow WS. Echocardiographic evaluation of the right ventricle: Clinical implications. Clin Cardiol 2017; 40:542-548. [PMID: 28295398 DOI: 10.1002/clc.22694] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 12/17/2022] Open
Abstract
Interest in evaluation of the right ventricle (RV) has increased recently. With the growth of new echocardiographic techniques and technology, there has been a corresponding increase in the ability to evaluate the RV, both qualitatively and quantitatively. Older echocardiographic techniques, such as right ventricular fractional area of change, tricuspid annular plane systolic excursion, and tissue S', and newer echocardiographic techniques including 3-dimensional evaluation and global longitudinal strain, can improve our evaluation of RV function. These techniques provide both diagnostic and prognostic data on a large variety of clinical diseases including pulmonary hypertension and congestive heart failure. With the continuing and exponential advances in technology, echocardiography is well poised to become the primary modality to evaluate the RV.
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Affiliation(s)
- Tanya Dutta
- Cardiology Division, Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, New York
| | - Wilbert S Aronow
- Cardiology Division, Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, New York
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Weekes AJ, Johnson AK, Troha D, Thacker G, Chanler-Berat J, Runyon M. Prognostic Value of Right Ventricular Dysfunction Markers for Serious Adverse Events in Acute Normotensive Pulmonary Embolism. J Emerg Med 2016; 52:137-150. [PMID: 27751702 DOI: 10.1016/j.jemermed.2016.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/27/2016] [Accepted: 09/05/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Right ventricular dysfunction (RVD) in pulmonary embolism (PE) has been associated with increased morbidity. Tools for RVD identification are not well defined. The prognostic value of RVD markers to predict serious adverse events (SAE) during hospitalization is unclear. OBJECTIVE Prospectively compare the incidence of SAE in normotensive emergency department patients with PE based upon RVD by goal-directed echocardiography (GDE), cardiac biomarkers, and right-to-left ventricle ratio by computed tomography (CT). Simplified Pulmonary Embolism Severity Index (sPESI) was calculated. Deaths and readmissions within 30 days were recorded. METHODS Consecutive normotensive PE patients underwent GDE focused on RVD (RV enlargement, hypokinesis, or septal bowing), serum troponin, and brain natriuretic peptide (BNP), and evaluation of the CT ventricle ratio. In-hospital SAE and complications within 30 days were recorded. RESULTS We enrolled 123 normotensive PE patients (median age 59 years, 49% female). Twenty-six of 123 (26%) patients had one or more SAE. RVD was detected in 26% by GDE, in 39% by biomarkers, and in 38% with CT. In-hospital SAE included one death, six respiratory interventions, six dysrhythmias, three major bleeding episodes, and 21 hypotension episodes. Forty-one percent of patients RVD positive by GDE had SAE, compared to the 18% RVD negative by GDE. Odds ratios for GDE, CT, BNP, troponin, and sPESI for SAE were 3.2 (95% confidence interval [CI] 1.2-8.5), 2.0 (95% CI 0.8-5.1), 3.3 (95% CI 1.3-8.6), 4.2 (95% CI 1.4-13.5), and 2.9 (95% CI 1.1-8.3), respectively. Five patients had non-PE-related deaths within 30 days. CONCLUSION The incidence of SAE within days of PE was significant in our cohort. Those with RVD had an increased risk of nonmortality SAE.
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Affiliation(s)
| | | | - Daniel Troha
- Carolinas Medical Center, Charlotte, North Carolina
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