[The role of non-invasive diagnostics of pulmonary embolism in the optimization of treatment].
177 patients with pulmonary embolism (PE) were examined to study the information value of transthoracal echoCG in early diagnostics of the disease, the possibility of noninvasive evaluation of its severity, and possibility of determining indications for thrombolytic therapy (TLT) on basis of such evaluation. The results show that the sensitivity of such a sign as elevation of pulmonary artery pressure (PAP) by 30 mmHg, is 95%, provided that the patient does not have severe or moderate concomitant diseases cousing PAP elevation (postinfarction cardiosclerosis, chronic obstructive lung disease, valvular diseases etc.). The specificity of this sign, vs the control group, was 5%. Thus, elevation of PAP in patients with clinical manifestations of PE and without concomitant pathology, is a highly informative symptom of acute PE. The sensitivity of the parameter of right ventricular (RV) dilatation was 85%, of paradoxial ventricular septum motion--54%. In patients with PE of various degree of severity and concomitant diseases, high sensitivity of the above-listed sonographic signs of RVoverload goes together with their low specificity, which is not higher than 25%. This does not allow evaluating the degree of embolism and determining indications for TLT in these patients on basis of echoCG data. The authors of the article have developed an algorithm of diagnostic and therapeutic measures in patients with suspected PE.
Ipatov
P V
PV
Nikitin
A V
AV
Fursov
A N
AN
Kolebaev
D V
DV
Sobolev
V V
VV
D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy; D016278:Ventricular Function, Right / Q000502:physiology