Comparison of degree of stenosis and plaque volume for the assessment of carotid atherosclerosis using 2-D ultrasound.

The degree of carotid stenosis (%ST) remains the most frequently used parameter for identifying patients with high risk of stroke but the relationship between %ST and the occurrence of stroke remains controversial. The objectives of this study were to check (1) the relationship between the %ST and the plaque volume index (PVI) as measured by echography and Doppler, (2) the relationship between the intima media thickness (IMT), a vessel wall remodeling index and the PVI an atheromatous growth index. For each of the 128 patients, (165 carotid stenosis), we measured the % ST (section or diameter), the max stenosis velocity (V(max)), the PVI and the common carotid IMT. The %ST (section) ranged from 10% to 93% (mean 66+/-18), V(max) from 0.3m/s to 3m/s (mean 1.2+/-0.8), PVI from 0.61cm(3) to 1.17cm(3) (mean 0.41+/-0.21) and the IMT from 0.08cm up to 0.31cm (mean 0.12+/-0.03). There was no significant correlation between either PVI and %ST (section or diameter), PVI and minimal stenosis section area (S1) or between PVI and V(max). There was no significant correlation between IMT and both %ST area and PVI. PVI was significantly correlated with the whole artery section area (S2) and the plaque length (L). The %ST (section or diameter) was significantly correlated with S1 but not with S2. The absence of correlation between the PVI and the %ST confirm that these two parameters describe two different processes of the atheromatous development.

Prognostic value of echocardiographic right/left ventricular end-diastolic diameter ratio in patients with acute pulmonary embolism: results from a monocenter registry of 1,416 patients.

BACKGROUND: In the literature, echocardiographic assessment of the prognosis of acute pulmonary embolism is based on analysis of right ventricle free-wall motion or on a composite index combining right ventricular dilatation, paradoxical septal wall motion, and pulmonary hypertension. The aim of this study was to determine the prognostic value of a single quantitative echocardiographic criterion, the right/left ventricular end-diastolic diameter (RV/LV) ratio. METHODS: Registry data on 1,416 consecutive patients hospitalized for acute pulmonary embolism were used to study retrospectively a population of 950 patients who underwent echocardiographic assessment on hospital admission and for whom the RV/LV ratio was available. RESULTS: The hospital mortality rate for the series was 3.3%. Sensitivity and specificity of RV/LV ratio >or= 0.9 for predicting hospital mortality were 72% and 58%, respectively. Multivariate analysis showed the independent predictive factors for hospital mortality to be the following: systolic BP < 90 mm Hg (odds ratio [OR], 10.73; p < 0.0001), history of left heart failure (OR, 8.99; p < 0.0001), and RV/LV ratio >or= 0.9 (OR, 2.66; p = 0.01). CONCLUSIONS: In our retrospective series, an echocardiographic RV/LV ratio >or= 0.9 was shown to be an independent predictive factor for hospital mortality. This criterion may be of value in selecting cases of submassive pulmonary embolism with a poor prognosis that are liable to benefit from thrombolytic treatment.

[Major pulmonary embolism]. / Les formes graves d'embolie pulmonaire.

The diagnosis of major pulmonary embolism should be considered in case of acute respiratory distress, particularly in high thrombo-embolic risk situation. Clinical examination, combined with blood gas analysis, electrocardiogram and chest X-ray are generally suggestive of pulmonary embolism but are not sufficient. In patients with shock, hypotension or after cardiac arrest (massive forms), bedside transthoracic echocardiography is the first choice diagnostic test whereas CT-scan should be considered in less severely ill patients. Troponin dosage and measurement of right upon left ventricular diameter ratio (by echocardiography or CT-scan) are mandatory in the prognostic evaluation of submassive forms (i.e. hemodynamically stable patients with right ventricular dysfunction). Thrombolysis is clearly indicated in patients suffering from massive pulmonary embolism and should be discussed in young patients (less than 70 years), with no identified bleeding risk, suffering from submassive form when troponin rate is increased and/or ventricular diameter ratio is over 0.9. Surgical embolectomy should be considered in case of contraindication or failure of thrombolysis.