Focused transthoracic echocardiography in acute pulmonary embolism: a systematic review and meta-analysis of diagnostic accuracy.

Abstract

Computed tomography pulmonary angiography is the diagnostic gold standard for acute pulmonary embolism, but delays and radiation risks necessitate rapid bedside alternatives. To evaluate the diagnostic accuracy of isolated point-of-care focused echocardiography and a combined approach of focused echocardiography and lower limb deep vein ultrasound for suspected acute pulmonary embolism. Systematic review and meta-analysis. Adult patients presenting to acute healthcare settings with suspected acute pulmonary embolism. Specific morphological signs [dilated right ventricle (RV), tricuspid annular plane systolic excursion] and highly specific functional signs [McConnell's sign, the 60/60 sign, abnormal interventricular motion, RV outflow tract early systolic notching (ESN), and clot-in-transit] assessed via isolated focused echocardiography, alongside a combined echocardiography and deep vein ultrasound strategy. Bivariate random-effects meta-analysis to determine pooled sensitivity and specificity. Thirty-three studies (3981 patients) were included. Isolated focused echocardiography signs demonstrated poor sensitivities (0.03-0.65) but high specificities, including McConnell's sign (0.98), the 60/60 sign (0.93), and RV outflow tract ESN (0.98). The combined echocardiography and deep vein ultrasound approach yielded a pooled sensitivity of 0.62 and a pooled specificity of 0.98. In this meta-analysis, isolated focused echocardiography signs demonstrated a reportedly low sensitivity but high specificity for the diagnosis of acute pulmonary embolism. Integrating lower limb deep vein ultrasound improves diagnostic sensitivity, though definitive exclusion still requires computed tomography.