Investigation of diagnostic value of cardiogoniometri in acute pulmonary embolism patients in emergency department

Background and Purpose: Acute pulmonary embolism is an emergency cardiovasculer disease that can be serious clinical outcomes. The increase of level of cardiac troponin values have been shown to be associated with the severity of pulmonary embolism. However , high cardiac troponin values need to be considered many diseases , especially cardiac diseases, in differential diagnosis. Cardiogoniometry is a diagnostic tool used in diagnosis of acute coronary syndrome. Main purpose is to determine diagnostic value of Cardiogoniometry (CGM) in patients with acute pulmonary embolism(APE), to evaluate used of cardiogoniometry in discrimination massive and non-massive pulmonary embolism and to research the contribution of cardiogoniometry patients with false troponin elevation in differential diagnosis. Materials and Method: This study that was designed as a prospective cross sectional research and held in Ege University Medicine Faculty Emergency Service between 15 July 2015 and 31 November 2015. Patients complaining of shortness of breath, chest pain who have done Multi-Dedector Tomographic (MDCT) angiography scanning for pulmonary embolism differential diagnosis were included in the study. All of the patients were evaluated with cardiogoniometry before MDCT scanning. Echocardiography was performed in order to evaluate the right structure of the heart in patients diagnosed radiological massive pulmonary embolism. The age, sex, vital signs, oxygen saturation, Wells clinical score, cardiac troponin values, multi-dedector tomographic results, cardiogoniometry results, echocardiography results were examined. Findings: 87 patients had Multi-Dedector Tomographic angiography scanning for PE differential diagnosis and 44 patients with pulmonary embolism diagnosis were included in the study. 26 (59,1%) patients were female , and average age was 67,2(±16,41). In 26 cases (59.1%) had radiological massive pulmonary embolism. As a result of echocardiography evaluation in patients with diagnosed radiological massive pulmonary embolism, 16 patients (61.5%) had dilation of the right structures of the heart. 35 patients' (50.7%) cardiac troponin values were above the cut-off value. 6 patients (18,2%) CGM results positive with acute pulmonary embolism and 5 patients (18,2%) CGM results were positive with radiological massive pulmonary embolism. As a result of compared with troponin value with MDCT in diagnosis of pulmonary embolism ; sensitivity of troponin:79,55%, spesitivite of troponin:20,9 % , positive predictive value of troponin:50,72% and negative predictive value of troponin:50% , were detected. Troponin had %73,08 of sensitivity and %11,11 of specity in separation of massive and non massive pulmonary embolism. Troponin had positive predictive value of 54,29% and negative predictive value of 22,22% in the diagnosis of massive pulmonary embolism. As a result of compared with cardiogoniometry results with MDCT in diagnosis of pulmonary embolism ; sensitivity of cardiogoniometry:13,6%, spesitivite of cardiogoniometry:81,6% , positive predictive value of cardiogoniometry:42,86% and negative predictive value of cardiogoniometry:47,95% were detected. Cardiogoniometry had %19,03 of sensitivity and %94,4 of specity in separation of massive and non massive pulmonary embolism. Cardiogoniometry had positive predictive value of 83,3% and negative predictive value of 44,7% in the diagnosis of massive pulmonary embolism. . Discussion and Conclusion: Due to the low sensitivity (%13,6), cardiogoniometry can not be used as a diagnostic strategy for diagnosis of acute pulmonary embolism. However ,it had high positive predictive value (PPV: 84%) [Troponin PPV: 54.29%] of the distinction massive and non massive pulmonary embolism. Positive cardiogoniometry results in a patient with acute pulmonary embolism means 84% probality of massive pulmary embolism