0
Pulmonary Vascular Disease |

Diagnostic Accuracy of Transesophageal Echocardiography in Suspected Central Pulmonary Embolism: A Meta-analysis

Nimeh Najjar; Abubakr Bajwa; Adil Shujaat
Author and Funding Information

Internal Medicine, University of Florida Health Jacksonville, Jacksonville, FL


Chest. 2014;146(4_MeetingAbstracts):822A. doi:10.1378/chest.1993783
Text Size: A A A
Published online

Abstract

SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Pulmonary embolism (PE) is a preventable cause of death. Early identification and treatment can save lives. Computed tomography pulmonary angiography (CTPA) and pulmonary angiography (PA) are considered the gold standard for diagnosis of PE. However, in a critically ill patient with suspected PE these imaging techniques are time consuming and require transportation. Moreover, they may not be an option in the morbidly obese or in those with poor kidney function. On the other hand, trans-esophageal echocardiography (TEE) can be performed rapidly at the bedside to look for central PE. We sought to perform a literature search for studies that reported on the diagnostic accuracy of TEE in suspected central PE.

METHODS: We performed a PUBMED search using the terms “pulmonary embol*” and transesophageal echo*”. We also searched the reference lists of the initially identified studies for any additional relevant studies. We included studies that met the following criteria: 1. Prospective, 2. Consecutive patients with suspected PE, 3. TEE compared to a reference test: normal or high probability V/Q scan, CTPA, PA, surgery or autopsy, and 4. Data available to create 2x2 table. We used MetaAnalyst beta 3.13 to perform the meta-analysis.

RESULTS: Five studies met our inclusion criteria. There was a total of 242 patients with suspected PE. All studies included only patients with evidence of right ventricular overload on transthoracic echocardiography. All except one excluded patients with known cardiopulmonary disease. The pooled estimate and 95% CI were: accuracy 84.2% (78.9-88.3), diagnostic odds ratio 70.3 (21.2-233.5), sensitivity 80.3% (73.6-85.6), specificity 93.4% (82.6-97.7), positive predictive value 97% (91.7-98.9), negative predictive value 64.3% (53.9-73.4), positive likelihood ratio 11.7 (4.3-32), and negative likelihood ratio 0.21 (0.15-0.29).

CONCLUSIONS: TEE can confirm the diagnosis in those with suspected central PE but it cannot exclude PE.

CLINICAL IMPLICATIONS: TEE offers a rapid bedside method of confirming the diagnosis of PE in critically ill patients with suspected central PE who cannot undergo CTPA or PA.

DISCLOSURE: The following authors have nothing to disclose: Nimeh Najjar, Abubakr Bajwa, Adil Shujaat

No Product/Research Disclosure Information


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543