PURPOSE: Some biochemical markers and echocardiographic abnormalities suggestive of right ventricular dysfunction have been reported as poor prognostic factors in patients with pulmonary emboli (PE). Controversy surround the utility of McConnell sign defined as RV free wall hypokinesis in the presence of normal RV apical contractility with variable sensitivity (16 to 77%) and specificity (94-100%) for the diagnosis of PE.The goal of this study was to evaluate prognostic markers, including the utility of McConnel sign in PE in an inner city population.
METHODS: Retrospectively chart review of all patients with the diagnosis of acute PE during January 2007 to September 2009. In addition all patients with a McConnell sign positive during the same period were analyzed.
RESULTS: 202 patients met inclusion criteria; 90(45%) males and 112(55%) females with an average age of 59 years. Common co-morbidities were hypertension (65%), diabetes (26%) and HIV infection (14%). All patients were hemodynamically stable. Ninety-four patients had d-dimers done ; elevated values were seen in 86%. 21(13%) of 168 patients had positive troponins. Twenty-three (11%) patients died. Age, sex, troponins or echocardiographic findings were not predictive of mortality. Elevated pro-BNP was predictive of mortality. Analysis of the 132 (65%) patients with available echocardiogram revealed: four with McConell’s sign (1.9%), 9 (7%) with EF< 40% and 76(58%) with pulmonary hypertension (RVSP>35mmHg). During the study period there were a total of eight patients with McConell’s sign on echocardiogram; four had PE, one no PE and in three PE was not ruled out. Out of the four patients with McConell’s sign, three had increased pro-BNP and d-dimers; none died.
CONCLUSION: Contrary to other studies, in our inner-city population with acute hemodynamically stable PE, neither echocardiogram nor positive troponins were able to predict outcome. Elevated ProBNP predicted mortality. McConell’s sign is a rare finding.
CLINICAL IMPLICATIONS: On patients with acute PE, clinicians need to be careful making prognostic decisions based solely on biochemical or echocardiographic abnormalities. Finding of McConell’s sign should prompt search for PE.
DISCLOSURE: Muhammad Anwer, No Financial Disclosure Information; No Product/Research Disclosure Information