الفهرس 
AcknowledgementsOnly 14 pages are availabe for public view
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Abstract
Pulmonary embolism (PE) is a serious disease of non-specific clinical manifestations and examination resulting in high rates of misdiagnosis, Computed tomographic pulmonary angiography (CTPA), is the gold standard method of diagnosis. Risk stratification of non-high-risk APE patients is based on clinical presentation, cardiac laboratory biomarkers, and signs of right ventricular (RV) dysfunction on echocardiography or CT. It was reported that tricuspid annulus plane systolic excursion (TAPSE) and tricuspid regurgitation peak gradient (TRPG) can be used for risk stratification of normotensive APE patients. The present prospective cross-sectional study was conducted to study the diagnostic and prognostic value of echocardiographic parameters in patients with intermediate pulmonary embolism, and to analyze the prognostic value of a new echocardiographic parameter, TRPG/ TAPSE, for prediction of APE-related 30-day death or the need for rescue thrombolysis in initially normotensive APE patients. The study has been conducted at Chest Department, Assiut University Hospital, from June 2019 to May 2021. Sixty patients (24 males and 36 females) were enrolled in this study. Diagnosis of APE based on (CTPA). All patients were subjected to full medical history and clinical examination, arterial blood gases complete blood count, ECG, plain chest X-ray, CT, Doppler of lower limbs, troponin test, D dimer test, and transthoracic echocardiography (TTE) Based on risk stratification (RS), 60 patients were subdivided to two groups. group I with intermediate low risk 32 (53.3%) and group II with intermediate high risk 28 (46.7%). There were non-significant differences between both groups as regard demographic data risk factors and comorbidities. The most frequent risk factors among patients in both groups were lower limb fracture, DVT and contraceptive pills. As regard comorbidities, diabetes mellitus and hypertension were the most frequent comorbidities among patients with both low and high intermediate risk. Diabetes mellitus was present in both groups (15.6% and 14.3% of low and high intermediate risk group, respectively) and hypertension was present in both groups (6.3% and 7.1% of intermediate low & high risk group, respectively). It was found that the presence of underlying cardiac disease, bronchiectasis, COPD and OHS were each present in only one patient of intermediate low risk group while each of SLE, and bronchiectasis was present in only one patient in intermediate high risk group, two patients with intermediate high risk had malignant lesions. Both groups of patients showed non-significant differences as regard clinical manifestations except for dyspnea. Majority (71.4%) of patients with intermediate high risk had dyspnea grade-IV while majority (59.3%) of those with intermediate low risk had dyspnea grade-III with significant difference (p=0.01). Syncope was reported in only two patients with intermediate high risk group. Three patients (10.7%) with intermediate high risk and seven patients (21.9%) with intermediate low risk had cough and hemoptysis. Majority of patients (56.3% of intermediate low risk group and 89.3% of intermediate high risk group) had respiratory rate > 30 cycle/minute with statistical significant difference between both groups (p=0.01). All patients had tachycardia. Both groups of patients showed non-significant differences as regard baseline arterial blood gases and baseline laboratory data with the exception of troponin level; that all patients with intermediate high risk had positive troponin while only 11 (34.4%) patients with intermediate low risk had positive troponin (p< 0.001) As regard chest x-ray findings; it was found that majority of patients (92.9% of intermediate high risk group and 65.6% of intermediate low risk group) had normal findings. In intermediate low risk group, one patient had consolidation and another patient had wedge shape opacity. Pleural effusion was detected in only five patients and Hampton Hump sign was found in four patients. In intermediate high risk group, one patient had Hampton Hump sign and wedge shape opacity was also found in only one patient.