***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE : To investigate the prognostic value of echocardiographic findings in patients who present with symptoms suggestive of acute pulmonary embolism . DESIGN : 317 patients with clinical ly suspected pulmonary embolism were prospect ively evaluated by echocardiography for the presence of right ventricular afterload stress and right heart or pulmonary artery thrombi . Objective confirmation of pulmonary embolism by lung scan or pulmonary angiography was obtained in 164 ( 52 % ) . The presence of deep venous thrombosis was established in 90 of 158 patients ( 57 % ) who underwent phlebographic or Doppler sonographic studies . RESULTS : Right ventricular afterload stress was diagnosed in 87 patients ( 27 % ) . Objective confirmation of pulmonary embolism and diagnosis of deep venous thrombosis was more common in patients with right ventricular afterload stress than in those without ( 83 % v 40 % and 46 % v 22 % , respectively ; P < 0.001 ) . This was also true for the detection of thrombi in the right heart and major pulmonary arteries ( 12 patients v 1 patient ; P < 0.001 ) as well as for the in-hospital mortality from venous thromboembolism ( 13 % v 0.9 % ; P < 0.001 ) . One year mortality from pulmonary embolism was 13 % in patients with right ventricular afterload stress at presentation compared with 1.3 % in those without ( P < 0.001 ) . CONCLUSIONS : The presence of right ventricular afterload stress detected by echocardiography is a major determinant of short term prognosis in patients with clinical ly suspected acute pulmonary embolism STUDY OBJECTIVE The objective of this study was to determine the diagnostic performance of right ventricular dilatation identified by emergency physicians on bedside echocardiography in patients with a suspected or confirmed pulmonary embolism . The secondary objective included an exploratory analysis of the predictive value of a subgroup of findings associated with advanced right ventricular dysfunction ( right ventricular hypokinesis , paradoxical septal motion , McConnell 's sign ) . METHODS This was a prospect i ve observational study using a convenience sample of patients with suspected ( moderate to high pretest probability ) or confirmed pulmonary embolism . Participants had bedside echocardiography evaluating for right ventricular dilatation ( defined as right ventricular to left ventricular ratio greater than 1:1 ) and right ventricular dysfunction ( right ventricular hypokinesis , paradoxical septal motion , or McConnell 's sign ) . The patient 's medical records were review ed for the final reading on all imaging , disposition , hospital length of stay , 30-day inhospital mortality , and discharge diagnosis . RESULTS Thirty of 146 patients had a pulmonary embolism . Right ventricular dilatation on echocardiography had a sensitivity of 50 % ( 95 % confidence interval [ CI ] 32 % to 68 % ) , a specificity of 98 % ( 95 % CI 95 % to 100 % ) , a positive predictive value of 88 % ( 95 % CI 66 % to 100 % ) , and a negative predictive value of 88 % ( 95 % CI 83 % to 94 % ) . Positive and negative likelihood ratios were determined to be 29 ( 95 % CI 6.1 % to 64 % ) and 0.51 ( 95 % CI 0.4 % to 0.7 % ) , respectively . Ten of 11 patients with right ventricular hypokinesis had a pulmonary embolism . All 6 patients with McConnell 's sign and all 8 patients with paradoxical septal motion had a diagnosis of pulmonary embolism . There was a 96 % observed agreement between coinvestigators and principal investigator interpretation of images obtained and recorded . CONCLUSION Right ventricular dilatation and right ventricular dysfunction identified on emergency physician performed echocardiography were found to be highly specific for pulmonary embolism but had poor sensitivity . Bedside echocardiography is a useful tool that can be incorporated into the algorithm of patients with a moderate to high pretest probability of pulmonary embolism BACKGROUND Transthoracic echocardiography ( TTE ) is used in the risk assessment of patients with pulmonary embolism ( PE ) , but the incremental diagnostic information from quantitative measures of right ventricular ( RV ) size , pressure , and function by TTE has yet to be fully evaluated . METHODS In 300 consecutive patients with suspected first nonmassive PE , TTE and ventilation/perfusion scintigraphy  were performed . RESULTS Among measures of RV anatomy , RV pressure estimates , and estimates of global and regional RV function with significant diagnostic information in a logistic regression analysis , the acceleration time of RV outflow less than 89 milliseconds , the ratio of RV to left ventricular diameter greater than 0.78 , RV outflow tract fractional shortening less than 35 % , and signs of RV strain on electrocardiogram had independent , incremental diagnostic information ( area under the receiver operating characteristics curve = 0.81 ) . If D-dimer greater than 4.1 mmol/L was included , the area under the curve increased to 0.88 . The negative and positive predictive values if any 2 of 3 factors in the final model were present were 88 % and 70 % , respectively . CONCLUSION TTE is able to identify differential diagnoses and enhance pretest probability of PE significantly . TTE could therefore be considered as an integral part of the initial diagnostic workup of patients suspected of PE , especially if definitive diagnostic imaging has limited availability Transthoracic echocardiography and continuous wave Doppler were prospect ively performed in 132 out- patients with suspicion of pulmonary embolism , and who had no previous history of severe cardiac or pulmonary disease . Bedside echocardiography determined diagnosis other than pulmonary embolism in 55 patients . Further study was completed in 70 patients ; pulmonary embolism was found in 31 and excluded in 39 . Significant differences were found as regards right ventricular diameter ( 27 + /- 8 vs 22 + /- 5 mm , P < 0.001 ) , left ventricular diameter ( 41 + /- 9 vs 49 + /- 7 mm , P < 0.001 ) , right over left ventricular diameter ratio ( 0.67 + /- 0.23 vs 0.43 + /- 0.15 , P < 0.0001 ) , tricuspid regurgitant flow peak velocity ( 2.9 + /- 0.4 vs 2.4 + /- 0.7 m.s-1 , P < 0.0001 ) , and abnormal septum motion ( 12 vs 4 , P < 0.01 ) . Multivariate analysis of echocardiographic data included a tricuspid regurgitant flow peak velocity greater than 2.5 m.s-1 and a right over left ventricular diameter ratio greater than 0.5 in a logistic model ( sensitivity 93 % , specificity 81 % ) . The combination of echocardiographic and non-echocardiographic data included the two previous echocardiographic variables , together with signs of deep vein thrombosis , a deep S wave in lead D1 , and a Q wave in lead D3 on the electrocardiogram in a logistic model ( sensitivity 96 % , specificity 83 % ) . It can be concluded that emergency echocardiography , alone or combined with clinical examination and electrocardiogram , satisfactorily predicts acute pulmonary embolism In a prospect i ve study all  positive phlebographies within the well-defined population of the city of Malmö , Sweden , during 1987 were studied in order to determine the incidence of  deep venous thrombosis ( DVT ) .  Epidemiological data were analysed for the detection of patient groups at increased risk of DVT .  The incidence was found to be equal for both sexes , i.e. 1.6 per 1000 inhabitants a year . Risk factors were found to be in accordance with earlier studies . The median age for men was 66 years , compared to 72 years for women . At diagnosis of DVT , 19 % of subjects had a known malignancy and within 1 year 5 % ( 19 cases ) developed a new malignancy . Of the men , 29 % had  postoperative or post-traumatic ( fracture ) DVT  , compared to 46 % of the women . Fewer patients with DVT than expected ( 39 % ) belonged to blood group 0 ( 31 % ) ( P less than 0.005 ) . Pulmonary embolism ( PE ) was clinical ly suspected in only 5 % of cases , and diagnosis was verified scintigraphically in 2 % of cases . None of these died of PE , but of 6 patients who were found to have PE at autopsy , four died about 4 weeks after the DVT was diagnosed BACKGROUND Acute pulmonary embolism ( APE ) is a common disease which is associated with high mortality and morbidity . Circulating level of copeptin , which was demonstrated to be elevated in heart failure , acute myocardial infa rct ion and pulmonary arterial hypertension , were reported to be independent predictors of poor outcome in recent studies . The aim of the present study was to investigate the clinical utility of copeptin in the diagnosis of APE . METHODS A total of 90 consecutive patients , admitted to emergency service due to acute chest pain and /or dyspnea and who underwent pulmonary computerized tomography angiography ( CTA ) due to suspicion of APE , were included in this prospect i ve study . The patients diagnosed with APE were defined as APE ( + ) group and the remaining individuals with normal pulmonary CTA result were defined as APE ( - ) group . RESULTS Copeptin levels ( 7.76 ± 4.4 vs. 3.81 ± 1.34 ng/dL ; p < 0.001 ) were higher in the APE ( + ) group as compared to the APE ( - ) group . Copeptin was significantly positively correlated with B-type natriuretic peptide ( r = 0.434 , p < 0.001 ) , D-dimer ( r = 0.315 , p = 0.003 ) and troponin I ( r = 0.300 , p = 0.004 ) and inversely correlated with arterial oxygen saturations ( r = -0.533 , p < 0001 ) . When the correlation of copeptin with right ventricular dysfunction parameters was investigated , it was significantly inversely correlated with the tricuspid annular plane systolic excursion ( r = -0.521 , p < 0.001 ) and positively correlated with right to left ventricle ratio ( r = 0.329 , p = 0.024 ) . Copeptin ( OR 1.836 , 95 % CI 1.171 - 2.878 , p = 0.008 ) was found as a significant independent predictor of APE in a multivariate analysis , after adjusting for other risk parameters . CONCLUSIONS Copeptin is a promising new biomarker , which may be used to support the need for further investigations and to improve the diagnosis of patients with APE PURPOSE Echocardiography is advocated by some as a useful diagnostic test for patients with suspected pulmonary embolism ( PE ) , but its diagnostic accuracy is unknown . The present study was undertaken to determine prospect ively the sensitivity and specificity of transthoracic echocardiography in the diagnosis of PE . SUBJECTS AND METHODS We examined 110 consecutive patients with suspected PE . The study protocol included assessment of clinical probability , echocardiography , and perfusion lung scanning . Pulmonary angiography was performed in all patients with abnormal scans . As echocardiographic criteria to diagnose acute PE , we used the presence of any two of the following : right ventricular ( RV ) hypokinesis , RV end-diastolic diameter > 27 mm ( without RV wall hypertrophy ) , or tricuspid regurgitation velocity > 2.7 m/sec . Clinical estimates of PE served as pretest probabilities in calculating , after echocardiography , the posttest probabilities of PE . RESULTS Pulmonary angiography confirmed PE in 43 ( 39 % ) of 110 patients . Echocardiographic diagnostic criteria for PE yielded a sensitivity of 56 % and a specificity of 90 % . For pretest probabilities of 10 % , 50 % , and 90 % , the posttest probabilities of PE conditioned by a positive echocardiogram were 38 % , 85 % , and 98 % , respectively . The posttest probabilities of PE conditioned by a negative echocardiogram were 5 % , 33 % , and 81 % , respectively . CONCLUSIONS In unselected patients with suspected PE , transthoracic echocardiography fails to identify some 50 % of patients with angiographically proven PE . Although echocardiographic findings of RV strain , paired with a high clinical likelihood , support a diagnosis of PE , the transthoracic echocardiography has to have a better sensitivity to be used as a screening test to rule out PE BACKGROUND AND OBJECTIVE A range of fixed-effect and r and om-effects meta-analytic methods are available to obtain summary estimates of measures of di 
    Output:
    
Conclusions : Studies show a consistently high specificity and low sensitivity for echocardiography in the diagnosis of PE , making it potentially adequate as a rule‐in test at the bedside in critical care setting s such as the emergency department and intensive care unit for patients with a suspicion of PE , especially those unable to get other confirmatory studies .
HighlightsThe current article represents one of the most thorough meta‐analyses of transthoracic echocardiography for pulmonary embolism to date and confirms a moderate sensitivity and high specificity across multiple echocardiographic parameters .
The test characteristics of echocardiography for pulmonary embolism are similar between cardiologists , cardiac sonographers , and physicians trained in point of care ultrasound .
Overall , echocardiography should not be used alone as test to rule out pulmonary embolism .