Pulmonary Vascular Disease |

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

Nimeh Najjar; Abubakr Bajwa; Adil Shujaat
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Internal Medicine, University of Florida Health Jacksonville, Jacksonville, FL

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

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