[Association of D-dimer and helicoidal thoracic scanner for diagnosis of pulmonary embolism. Prospective study of 106 ambulatory patients].
OBJECTIVE
Ventilation/perfusion pulmonary scintigraphy (PS), the current mainspring in the diagnosis of pulmonary oedema (PE), is frequently non-conclusive. The objective of this study was to determine, prospectively, the diagnostic value of the association of D-dimers and helicoidal thoracic scanner (HTS) in a continuous series of ambulatory adults with suspected PE and admitted to a cardiologic emergency unit.


METHODS
Exclusion criteria were as follows: symptoms or clinical signs of seventy, contraindication for HTS and/or on pulmonary angiography, curative anticoagulant therapy for more than 48 hours, history of PE less than 3 months before or the impossibility of conducting all the examinations with 48 hours. All the patients underwent determination of D-dimers by rapid ELISA test, HTS and 2 reference examinations, venous Doppler of the lower limbs and a PS, completed by pulmonary angiography if the PS did not permit diagnosis and the venous Doppler was negative.


RESULTS
One hundred and six patients were selected over a recruitment period of 18 months. The prevalence of PE was of 45% (48/106). Forty-four of the 48 PE of the series were central form. HTS was considered dubious in 10 patients (10.4%, PE+ n = 2, PE- n = 8). The results of D-dimers were negative in only 34.5% patients without PE (20/58). Pulmonary angiography was necessary in 15 patients. The negative and positive predictive values of D-dimers were respectively of 100 and 55.8% (48/86) and those of HTS respectively 100 (46/46) and 92% (46/50).


CONCLUSIONS
The diagnostic strategy of clinical suspicion of PE, starting with determination of D-dimers by rapid ELISA test followed by helicoidal thoracic scanner in the case of a positive result, was particularly effective in this series of patients with a high prevalence of PE. These results must be confirmed in a larger series and in a general emergency unit.
Pacouret
G
G
Unité de Soins Cardiaques Intensifs, Service de Cardiologie D, Hôpital Trousseau, F37044 Tours. drpacouret@online.fr
Marie
O
O
Alison
D
D
Delahousse
B
B
Fichaux
O
O
Peycher
P
P
Djeffal Vincentelli
D
D
Potier
J M
JM
Gruel
Y
Y
Charbonnier
B
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D019281:Dimerization; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood* / Q000175:diagnosis / Q000000981:diagnostic imaging*; D011859:Radiography