Prediction of pulmonary embolism extent by clinical findings, D-dimer level and deep vein thrombosis shown by ultrasound

被引:70
作者
Galle, C
Papazyan, JP
Miron, MJ
Slosman, D
Bounameaux, H
Perrier, A
机构
[1] Univ Hosp Geneva, Med Clin 1, CH-1211 Geneva 14, Switzerland
[2] Univ Hosp Geneva, Div Angiol & Hemostasis, CH-1211 Geneva 14, Switzerland
[3] Univ Hosp Geneva, Div Nucl Med, CH-1211 Geneva 14, Switzerland
关键词
pulmonary embolism; lung scan; prognosis;
D O I
10.1055/s-0037-1616044
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Pulmonary embolism (PE) may encompass a wide spectrum of severity. To determine whether clinical findings, D-dimer (DD) concentration,, and deep vein thrombosis (DVT) shown by lower-limb venous compression ultrasonography (US) might predict the scintigraphic extent of PE, we studied 104 hemodynamically stable consecutive outpatients with acute PE diagnosed by a high-probability ventilation-perfusion lung scan. Scintigraphic extent of PE was classified into three categories: perfusion defects corresponding to < 30%, 30-50%, or > 50% of the total lung area. Median respiratory and heart rates were found to be significantly related to the extent of PE. Higher median alveolar-arterial oxygen difference values were observed as the proportion of lung perfusion defects increased (> 50% vs. < 30%, 6.3 vs. 3.6 kPa, P < .0001). Median plasma DD concentration was 7950 mug/L in patients with > 50% perfusion defects compared to 2731 mug/L in those with < 30% defects (P =.0001). DD levels above 4000 mug/L were associated to more extensive perfusion defects (> 50% vs. < 30% defects, OR 30; 95% Cl 5.8-155). Finally, a proximal DVT was more likely among patients with larger perfusion defects (> 50% vs. < 30% defects, OR 4.5; 95% Cl 1.5-13.6). In conclusion, clinical signs such as tachypnea and tachycardia, alveolar-arterial oxygen difference, plasma DD concentration, and presence of DVT on US are predictors of a larger PE, as assessed by the extent of perfusion defects on high probability lung scans.
引用
收藏
页码:1156 / 1160
页数:5
相关论文
共 25 条
  • [1] Azarian R, 1997, J NUCL MED, V38, P980
  • [2] REAL-TIME ULTRASONOGRAPHY FOR THE DIAGNOSIS OF LOWER-EXTREMITY DEEP VENOUS THROMBOSIS - THE WAVE OF THE FUTURE
    BECKER, DM
    PHILBRICK, JT
    ABBITT, PL
    [J]. ARCHIVES OF INTERNAL MEDICINE, 1989, 149 (08) : 1731 - 1734
  • [3] MEASUREMENT OF D-DIMER IN PLASMA AS DIAGNOSTIC-AID IN SUSPECTED PULMONARY-EMBOLISM
    BOUNAMEAUX, H
    CIRAFICI, P
    DEMOERLOOSE, P
    SCHNEIDER, PA
    SLOSMAN, D
    REBER, G
    UNGER, PF
    [J]. LANCET, 1991, 337 (8735) : 196 - 200
  • [4] PULMONARY-EMBOLISM, PULMONARY HEMORRHAGE AND PULMONARY INFARCTION
    DALEN, JE
    HAFFAJEE, CI
    ALPERT, JS
    HOWE, JP
    OCKENE, IS
    PARASKOS, JA
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1977, 296 (25) : 1431 - 1435
  • [5] Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER)
    Goldhaber, SZ
    Visani, L
    De Rosa, M
    [J]. LANCET, 1999, 353 (9162) : 1386 - 1389
  • [6] ALTEPLASE VERSUS HEPARIN IN ACUTE PULMONARY-EMBOLISM - RANDOMIZED TRIAL ASSESSING RIGHT-VENTRICULAR FUNCTION AND PULMONARY PERFUSION
    GOLDHABER, SZ
    HAIRE, WD
    FELDSTEIN, ML
    MILLER, M
    TOLTZIS, R
    SMITH, JL
    DASILVA, AMT
    COME, PC
    LEE, RT
    PARKER, JA
    MOGTADER, A
    MCDONOUGH, TJ
    BRAUNWALD, E
    [J]. LANCET, 1993, 341 (8844) : 507 - 511
  • [7] Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction
    Grifoni, S
    Olivotto, I
    Cecchini, P
    Pieralli, F
    Camaiti, A
    Santoro, G
    Conti, A
    Agnelli, G
    Berni, G
    [J]. CIRCULATION, 2000, 101 (24) : 2817 - 2822
  • [8] Management strategies and determinants of outcome in acute major pulmonary embolism: Results of a multicenter registry
    Kasper, W
    Konstantinides, S
    Geibel, A
    Olschewski, M
    Heinrich, F
    Grosser, KD
    Rauber, K
    Iversen, S
    Redecker, M
    Kienast, J
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1997, 30 (05) : 1165 - 1171
  • [9] Konstantinides S, 1997, CIRCULATION, V96, P882
  • [10] Using clinical evaluation and lung scan to rule out suspected pulmonary embolism -: Is it a valid option in patients with normal results of lower-limb venous compression ultrasonography?
    Perrier, A
    Miron, MJ
    Desmarais, S
    de Moerloose, P
    Slosman, D
    Didier, D
    Unger, PF
    Junod, A
    Patenaude, JV
    Bounameaux, H
    [J]. ARCHIVES OF INTERNAL MEDICINE, 2000, 160 (04) : 512 - 516