The podcast discusses the effectiveness of early systolic notching as a marker for pulmonary embolism, exploring a prospective study's findings. They highlight the diagnostic accuracy and significance of this marker in detecting proximal obstruction in the pulmonary arteries, comparing its specificity with other diagnostic methods. The hosts review diverse patient cases and emphasize the need for further research to establish a definitive marker for PE assessment.
Early systolic notching has high specificity (97%) but low sensitivity (34%) in detecting pulmonary embolism.
The study highlights the need for further research on early systolic notching's predictive value in different patient populations.
Deep dives
Diagnostic Accuracy of Early Systolic Notching in Pulmonary Embolism
The podcast discusses a study published in the Journal of Ultrasound and Medicine in May 2021, analyzing the diagnostic accuracy of early systolic notching in pulmonary embolism. Early systolic notching is evaluated using pulse wave doppler to detect proximal obstruction in the pulmonary arteries, indicating a specific waveform characteristic. The study included 183 patients from academic emergency departments with suspected PE, showing that early systolic notching had a specificity of 97% but a low sensitivity of 34% for detecting PE.
Study Cohort and Findings
The study cohort comprised patients with a median age of 64, where 52.5% had PE, with notable occurrences of bilateral and main pulmonary artery embolisms. Among patients with PE, 19.7% exhibited early systolic notching. While the sensitivity of early systolic notching for detecting PE was limited at 34%, the specificity was high at 97%, indicating a higher likelihood of PE when early systolic notching was present.
Implications and Limitations
The podcast addresses the study's strengths, such as its prospective multi-center design and lack of exclusions based on other potential causes of findings. However, concerns were raised regarding the study's focus on diagnosing PE in patients with suspected PE rather than differentiating severity levels of PE. The significance of early systolic notching in predicting PE in various patient populations, including those with abnormal vital signs or higher risk profiles, remains an area for further exploration and validation.
Everyone's new favorite doppler marker for pulmonary embolism is back! We discussed the ESN (early systolic notching) when this concept was first introduced as a marker for large PEs, but now we have a prospective study that improves upon some of the limitations of the past article...or does it?