Vieillard-Baron A, Qanadli S D, Antakly Y, Fourme T, Loubières Y, Jardin F, Dubourg O
Intensive Care Unit, Hôpital Ambroise Paré, Boulogne, France.
Intensive Care Med. 1998 May;24(5):429-33. doi: 10.1007/s001340050591.
The goal of the study was to assess prospectively the value of transesophageal echocardiography (TEE) for the diagnosis of massive pulmonary embolism complicated by acute cor pulmonale.
A prospective study conducted on 44 consecutive patients.
A general intensive care unit (ICU) of a university hospital.
Between May 95 and October 96, 44 consecutive patients with clinically suspected acute pulmonary embolism underwent transthoracic echocardiography (TTE), completed by TEE when acute cor pulmonale was present (30 patients). The results of the echocardiographic studies were compared with radiological investigations by helical CT or contrast angiography.
The high sensitivity and specificity of the presence of acute cor pulmonale on TTE for the diagnosis of pulmonary embolism was confirmed. Nineteen patients only underwent TEE. The sensitivity and the specificity of TEE in detecting a proximal pulmonary embolism were 84% and 84%, respectively. Its main limitation concerned the left pulmonary artery, in which only one thrombus was visualized by TEE whereas six were present on helical CT, and lobar pulmonary arteries which could not be visualized with TEE. Thus, the overall sensitivity of TEE for the detection of pulmonary embolism with acute cor pulmonale was only 58%.
In comparison with radiological procedures, TEE had limited accuracy for detecting pulmonary embolism with acute cor pulmonale. When the pulmonary embolism was located in the main or right pulmonary artery, TEE could clarify the diagnosis within a few minutes without further invasive diagnostic procedures. However, a negative TEE did not exclude left proximal or lobar pulmonary embolism.
本研究的目的是前瞻性评估经食管超声心动图（TEE）对诊断合并急性肺心病的大面积肺栓塞的价值。
对44例连续患者进行的前瞻性研究。
一所大学医院的综合重症监护病房（ICU）。
在1995年5月至1996年10月期间，44例临床怀疑急性肺栓塞的连续患者接受了经胸超声心动图（TTE）检查，当存在急性肺心病时（30例患者），由TEE完成检查。将超声心动图研究结果与螺旋CT或造影血管造影的放射学检查结果进行比较。
证实了TTE上急性肺心病的存在对诊断肺栓塞具有高敏感性和特异性。19例患者仅接受了TEE检查。TEE检测近端肺栓塞的敏感性和特异性分别为84%和84%。其主要局限性在于左肺动脉，TEE仅能看到1个血栓，而螺旋CT显示有6个血栓，并且TEE无法看到叶肺动脉。因此，TEE检测合并急性肺心病的肺栓塞的总体敏感性仅为58%。
与放射学检查相比，TEE检测合并急性肺心病的肺栓塞的准确性有限。当肺栓塞位于主肺动脉或右肺动脉时，TEE可在几分钟内明确诊断，无需进一步的侵入性诊断程序。然而，TEE结果为阴性并不能排除左近端或叶肺动脉栓塞。
