Skip Navigation

European Heart Journal 2000 21(16):1301-1336; doi:10.1053/euhj.2000.2250
Copyright © 2000 by the European Society of Cardiology.
This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Google Scholar
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Task Force Report

Guidelines on diagnosis and management of acute pulmonary embolism

This document has been reviewed by members of the Committee for Scientific and Clinical Initiatives and by members of the Board of the European Society of Cardiology (see Appendix 1), who approved the document on 14 April 2000. The full text of this document is available on the website of the European Society of Cardiology in the section ‘Scientific Information’, Guidelines.

References

  1. Karwinski B, Svendsen E. Comparison of clinical and postmortem diagnosis of pulmonary embolism. J Clin Path. 1989;42:135–139[Abstract/Free Full Text]
  2. Mandelli V, Schmid C, Zogno C. ‘False negatives’ and ‘false positives’ in acute pulmonary embolism: A clinical-postmortem comparison. Cardiologia. 1997;42:205–210[Medline]
  3. Stein PD, Henry JW. Prevalence of acute pulmonary embolism among patients in a general hospital and at autopsy. Chest. 1995;108:78–81[Medline]
  4. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999;353:1386–1389[CrossRef][ISI][Medline]
  5. Tibbut DA, Chesterman CN. Pulmonary embolism: current therapeutic concepts. Drugs. 1976;11:161–192[ISI][Medline]
  6. Nicolaides AN, Arcelus J, Belcaro G. Prevention of venous thromboembolism. European consensus conference. Int Angiology. 1992;11:151–159
  7. Goldhaber SZ, Morpurgo M. Diagnosis, treatment and prevention of pulmonary embolism. Report of the WHO/ISFC Task Force. JAMA. 1992;268:1727–1733[Abstract]
  8. Van Beek EJR, ten Cate JW. The diagnosis of venous thromboembolism: an overview. Hull RD, Raskob GE, Pineo GF. Venous Thromboembolism: an evidence-based atlas. Armonk: Futura Publishing Co; 1996. p. 93–99
  9. Dismuke SE, VanderZwaag R. Accuracy and epidemiological implications of the death certificate diagnosis of pulmonary embolism. J Chron Dis. 1984;37:67–73[CrossRef][ISI][Medline]
  10. Stein PD. Pulmonary Embolism. Baltimore: William & Wilkins; 1996. p. 41–53
  11. Morpurgo M, Schmid C. Clinico-pathologic correlations in pulmonary embolism: a posteriori evaluation. Prog Resp Dis. 1980;13:8–15
  12. Goldhaber SZ. Strategies for diagnosis. Goldhaber SZ. Pulmonary Embolism and Deep Vein Thrombosis. Philadelphia: Saunders; 1985. p. 79–97
  13. Rubinstein I, Murray D, Hoffstein V. Fatal pulmonary emboli in hospitalized patients. An autopsy study. Arch Intern Med. 1988;148:1425–1426[Abstract]
  14. Gross JS, Neufeld RR, Libow LS, Gerber I, Rodstein M. Autopsy study of the elderly institutionalized patient. Review of 234 autopsies. Arch Intern Med. 1988;148:173–176[Abstract]
  15. Morpurgo M, Schmid C, Mandelli V. Factors influencing the clinical diagnosis of pulmonary embolism: analysis of 229 postmortem cases. Int J Cardiol. 1998;65:S79–S82[Medline]
  16. Diebold J, Loehrs U. Venous thrombosis and pulmonary embolism. A study of 5039 autopsies. Path Res Pract. 1991;187:260–266[Medline]
  17. Giuntini C, Di Ricco G, Marini C. Epidemiology. Chest. 1995;107:3S–9S[CrossRef][Medline]
  18. Ferrari E, Baudouy M, Cerboni P. Clinical epidemiology of venous thrombo-embolic disease. Results of a French multicentre registry. Eur Heart J. 1997;18:685–691[Abstract/Free Full Text]
  19. Lane DA, Mannucci PM, Bauer KA. Inherited thrombophilia: Part 1. Thromb Haemost. 1996;76:651–662[ISI][Medline]
  20. Lane DA, Mannucci PM, Bauer KA. Inherited thrombophilia: Part 2. Thromb Haemost. 1996;76:824–834[ISI][Medline]
  21. Dahlback B. Inherited thrombophilia: resistance to activated protein C as a pathogenetic factor of venous thromboembolism. Blood. 1995;85:607–614[Free Full Text]
  22. Bertina RM, Koeleman BPC, Koster T. Mutation in blood coagulation factor V associated with resistance to activated protein C. Nature. 1994;369:64–67[CrossRef][Medline]
  23. Poort SR, Rosendaal FR, Reitsma PH, Bertina RM. A common genetic variation in the 3'-untranslated region of the prothrombin gene is associated with elevated plasma prothrombin levels and an increase in venous thrombosis. Blood. 1996;88:3698–3703[Abstract/Free Full Text]
  24. Den Heyer M, Koster T, Blom HJ. Hyperhomocysteinemia as a risk factor for deep-vein thrombosis. N Engl J Med. 1996;334:759–762[Abstract/Free Full Text]
  25. Fermo I, Vigano D, Angelo S. Prevalence of moderate hyperhomocysteinemia in patients with early-onset venous and arterial occlusive disease. Ann Intern Med. 1995;123:747–753[Abstract/Free Full Text]
  26. Demers C, Ginsberg JS, Hirsh J, Henderson P, Blajchman MA. Thrombosis in antithrombin III deficient persons. Ann Intern Med. 1992;116:754–761[ISI][Medline]
  27. Heyboer H, Brandjes DPM, Büller HR, Sturk A, ten Cate JW. Deficiencies of coagulation-inhibiting and fibrinolytic proteins in outpatients with deep-vein thrombosis. N Engl J Med. 1990;323:1512–1515[Abstract]
  28. Piccioli A, Prandoni P, Goldhaber SZ. Epidemiologic characteristics, management, and outcome of deep vein thrombosis in a tertiary care hospital: The Brigham and Women's Hospital DVT Registry. Am Heart J. 1996;132:1010–1014[CrossRef][ISI][Medline]
  29. Lilienfeld DE, Goldbold JH, Burke GL. Hospitalization and case fatality for pulmonary embolism in the twin cities: 1979. Am Heart J. 1990;120:392–395[CrossRef][ISI][Medline]
  30. Anderson FA, Brownell-Wheeler H, Goldberg RJ. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. Arch Intern Med. 1991;151:933–938[Abstract]
  31. Bergqvist D, Lindblad B. Incidence of venous thromboembolism in medical and surgical patients. Bergqvist D. Prevention of Venous Thromboembolism. London: Med-Orion; 1994. p. 3–15
  32. Kniffin WD, Baron JA, Barrett J. The epidemiology of diagnose pulmonary embolism and deep vein thrombosis in the elderly. Arch Intern Med. 1994;154:861–866[Abstract]
  33. Gallus AS. Medical patients. Hull RD, Raskob GE, Pineo GF. Venous Thromboembolism: an evidence-based atlas. Armonk: Futura Publishing Co; 1996. p. 67–73
  34. Turpie AGG, Leclerc JR. Prophylaxis of venous thromboembolism. Leclerc JR. Venous Thromboembolic Disorders. Philadelphia: Lea Febiger; 1991. p. 303–345
  35. Josa M, Siouffi SY, Silverman AB. Pulmonary embolism after cardiac surgery. J Am Coll Cardiol. 1993;21:990–996[Abstract]
  36. Malone KM. Coronary artery bypass grafting. Goldhaber SZ. Prevention of Venous Thromboembolism. New York: Marcel Dekker; 1993. p. 439–444
  37. Huber O, Bounameaux H, Borst F. Postoperative pulmonary embolism after hospital discharge. Arch Surg. 1992;127:310–313[Abstract]
  38. Toglia MR, Weg JG. Venous Thromboembolism During Pregnancy. N Engl J Med. 1996;335:108–113[Free Full Text]
  39. Lancet. 1995;346:1575–1582[ISI][Medline]
  40. Jick H, Jick SS, Gurevich V. Risk of idiopathic cardiovascular death and non-fatal venous thromboembolism in women using oral contraceptives with different prostagen compounds. Lancet. 1995;346:1589–1593[CrossRef][ISI][Medline]
  41. Spitzer WO, Lewis MA, Heinemann LAJ. Third generation oral contraceptives and risk of venous thromboembolic disorders: an international case-control study. Br Med J. 1996;312:83–88[Abstract/Free Full Text]
  42. Grodstein F, Stampfer MJ, Goldhaber SZ. Prospective study of exogenous hormones and risk of pulmonary embolism in women. Lancet. 1996;348:983–987[CrossRef][ISI][Medline]
  43. Hulley S, Grady D, Bush T. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA. 1998;280:605–613[Abstract/Free Full Text]
  44. Goldhaber SZ, Grodstein F, Stampfer MJ. A prospective study of risk factors for pulmonary embolism in women. JAMA. 1997;277:642–645[Abstract]
  45. Baron JA, Gridley G, Weiderpass E, Nyren O, Linet M. Venous thromboembolism and cancer. Lancet. 1998;351:1077–1080[CrossRef][ISI][Medline]
  46. Cornuz J, Pearson SD, Creager MA, Cook EF, Goldman L. Importance of findings on the initial evaluation for cancer in patients with symptomatic idiopathic deep venous thrombosis. Ann Intern Med. 1996;125:785–793[Abstract/Free Full Text]
  47. Sorensen HT, Mellemkjaer L, Steffensen FH, Olsen JH, Nielsen GL. The risk of a diagnosis of cancer after primary deep venous thrombosis or pulmonary embolism. N Engl J Med. 1998;338:1169–1173[Abstract/Free Full Text]
  48. Hume M, Sevitt S, Thomas DP. Venous Thrombosis and Pulmonary Embolism. Cambridge: Harvard University Press; 1970. p. 206–7
  49. Monreal M, Lafoz E, Ruiz J. Upper-extremity deep venous thrombosis and pulmonary embolism. Chest. 1991;99:280–283[CrossRef][ISI][Medline]
  50. Polak JF. Venous ultrasound and doppler sonography. Goldhaber SZ. Prevention of Venous Thromboembolism. New York: Marcel Dekker; 1993. p. 87–126
  51. Moser KM. Pulmonary Embolism. Am Rev Resp Dis. 1977;115:829–852[ISI][Medline]
  52. Prandoni P, Polistena P, Bernardi E. Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complications. Arch Intern Med. 1997;157:57–62[Abstract]
  53. Coon WW, Coller FA. Clinicopathologic correlation in thromboembolism. Surg Gyn Obst. 1959;109:259–269[Medline]
  54. Koehn, H, Koenig, B, Mostbeck, A, Incidence and clinical feature of pulmonary embolism in patients with deep vein thrombosis: a prospective study, Eur J Nucl Med,1987, 13, S11, S15
  55. Kakkar VV, Flanc C, Howe CT, Clarke MB. Natural history of postoperative deep-vein thrombosis. Lancet. 1969;2:230–232[CrossRef][ISI][Medline]
  56. Sasahara AA, McIntyre KM, Cella G. The clinical and hemodynamic features of acute pulmonary embolism. Curr Pulmonol. 1988;9:305–346
  57. Colman NC. Pathophysiology of pulmonary embolism. Leclerc JR. Venous Thromboembolic Disorders. Philadelphia: Lea Febiger; 1991. p. 65–73
  58. Menzel T, Wagner S, Kramm T. Pathophysiology of impaired right and left ventricular function in chronic embolic pulmonary hypertension. Chest. 2000;:
  59. Dantzker DR. Pulmonary gas exchange. Dantzker DR. Cardiopulmonary Critical Care. Orlando: Grune Stratton; 1986. p. 25–46
  60. Sergysels R. Pulmonary gas exchange abnormalities in pulmonary embolism. Morpurgo M. Pulmonary Embolism. New York: Marcel Dekker; 1994. p. 89–96
  61. Dalen JE, Haffajee CI, Alpert JS. Pulmonary embolism, pulmonary hemorrhage and pulmonary infarction. N Engl J Med. 1977;296:1431–1435[Abstract]
  62. Leclerc JR. Natural history of venous thromboembolism. Leclerc JR. Venous Thromboembolic Disorders. Philadelphia: Lea Febiger; 1991. p. 166–175
  63. Neuhof H. Venous Thrombosis and Pulmonary Embolism. New York: Grune Stratton; 1948. p. 92–105
  64. Morpurgo M, Rustici A. Lo spettro dell'embolia polmonare. Cardiologia. 1988;33:1105–1108[Medline]
  65. Pacouret G, Alison D, Pottier JM. Free-floating thrombus and embolic risk in patients with angiographically confirmed proximal deep venous thrombosis. a prospective study. Arch Intern Med. 1997;157:305–308[Abstract]
  66. Barritt DW, Jordan SC. Clinical features of pulmonary embolism. Lancet. 1961;1:729–732[CrossRef][ISI][Medline]
  67. Goldhaber SZ, Hennekens CH, Evans D, Newton EC, Godleski JJ. Factors associated with correct antemortem diagnosis of major pulmonary embolism. Am J Med. 1982;73:822–826[CrossRef][ISI][Medline]
  68. Kasper W, Konstantinides S, Tiede N. Prognostic significance of right ventricular afterload stress detected by echocardiography in patients with clinically suspected pulmonary embolism. Heart. 1997;77:346–349[Abstract/Free Full Text]
  69. Ribeiro A, Lindmarker P, Juhlin-Dannfelt A. Echocardiography doppler in pulmonary embolism: right ventricular dysfunction as a predictor of mortality rate. Am Heart J. 1997;134:479–487[CrossRef][ISI][Medline]
  70. Konstantinides S, Geibel A, Kasper W. Patent foramen ovale is an important predictor of adverse outcome in patients with major pulmonary embolism. Circulation. 1988;97:1946–1951
  71. Farfel Z, Shechter M, Vered Z. Review of echocardiographically diagnosed right heart entrapment of pulmonary emboli-in-transit with emphasis on management. Am Heart J. 1987;113:171–178[CrossRef][ISI][Medline]
  72. Kinney REL, Wright RJ. Efficacy of treatment of patients with echocardiographically detected right-sided heart thrombi: A meta-analysis. Am Heart J. 1989;118:569–573[CrossRef][ISI][Medline]
  73. Kronik G. The European cooperative study on the clinical significance of right heart thrombi. Eur Heart J. 1989;10:1046–1059[Abstract/Free Full Text]
  74. Chartier L, Bera J, De Lomez M. Free floating thrombi in the right heart, diagnosis, management and prognostic indexes in 38 consecutive patients. Circulation. 1999;99:2779–2783[Abstract/Free Full Text]
  75. Casazza F, Bongarzoni A, Centonze F. Prevalence and prognostic significance of right-sided cardiac mobile thrombi in acute massive pulmonary embolism. Am J Cardiol. 1997;79:1433–1435[CrossRef][ISI][Medline]
  76. Widimský J. Mechanisms in embolic pulmonary hypertension. Wagenvoort CA, Denolin H. Pulmonary Circulation, Advances and Controversies. Amsterdam: Elsevier; 1989. p. 75–86
  77. Riedel M, Stanek V, Widimsky J, Prerovsky L. Long-term follow-up of patients with pulmonary thromboembolism. Late prognosis and evaluation of hemodynamic and respiratory data. Chest. 1982;81:151–158[CrossRef][ISI][Medline]
  78. Stein PD, Terrin ML, Hales CA. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest. 1991;100:598–603[CrossRef][ISI][Medline]
  79. Palla A, Petruzzelli S, Donnamaria V, Giuntini C. The role of suspicion in the diagnosis of pulmonary embolism. Chest. 1995;107:21S–24S[Medline]
  80. Miniati M, Prediletto R, Formichi B. Accuracy of clinical assessment in the diagnosis of pulmonary embolism. Am J Respir Crit Care Med. 1999;159:864–871[Abstract/Free Full Text]
  81. Stein PD, Goldhaber SZ, Henry JW, Miller AC. Arterial blood gas analysis in the assessment of suspected acute pulmonary embolism. Chest. 1996;109:78–81[Medline]
  82. Perrier A, Bounameaux H, Morabia A. Diagnosis of pulmonary embolism by a decision analysis-based strategy including clinical probability, D-dimer levels, and ultrasonography: a management study. Arch Intern Med. 1996;156:531–536[Abstract]
  83. Perrier A, Desmarais S, Miron MJ. Noninvasive diagnosis of venous thromboembolism. Lancet. 1999;353:190–195[CrossRef][ISI][Medline]
  84. Perrier A, Miron MJ, Desmarais S. Combining clinical probability and lung scan in suspected pulmonary embolism. Arch Intern Med. 2000;160:512–516[Abstract/Free Full Text]
  85. JAMA. 1990;263:2753–2759[Abstract]
  86. Wells PS, Ginsberg JS, Anderson DR. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med. 1998;129:997–1005[Abstract/Free Full Text]
  87. Celi A, Palla A, Petruzzelli S. Prospective study of a standardized questionnaire to improve clinical estimate of pulmonary embolism. Chest. 1989;95:332–337[CrossRef][ISI][Medline]
  88. Hoellerich VL, Wigton RS. Diagnosing pulmonary embolism using clinical findings. Arch Intern Med. 1986;146:1699–1704[Abstract]
  89. Wasson JH, Sox HC. Clinical prediction rules. Have they come of age? JAMA. 1996;275:641–642[CrossRef][ISI][Medline]
  90. Wyatt JC, Atman DG. Prognostic models: clinicallly useful or quickly forgotten? Br Med J. 1995;311:1539–1541[Free Full Text]
  91. Am J Respir Crit Care Med. 1996;154:1387–1393[Abstract]
  92. Miller RF, O'Doherty MJ. Pulmonary nuclear medicine. Eur J Nucl Med. 1992;19:355–368[ISI][Medline]
  93. Dalen JE, Haynes FW, Hoppin FG Jr, Evans GL, Bhardwaj P, Dexter L. Cardiovascular responses to experimental pulmonary embolism. Am J Cardiol. 1967;20:3–9[Medline]
  94. White PG, Hayward MWJ, Cooper T. Ventilation agents—what agents are currently used? Nucl Med Comm. 1991;12:349–352[ISI][Medline]
  95. McNeil BJ, Holman BL, Adelstein SJ. The scintigraphic definition of pulmonary embolism. JAMA. 1974;227:753–756[CrossRef][ISI][Medline]
  96. Biello DR, Mattar A, McKnight RC, Siegel BA. Ventilation-perfusion studies in suspected pulmonary embolism. Am J Roentgenol. 1979;133:1033–1037[Abstract]
  97. Hull RD, Raskob GE. Low-probability lung scan findings: a need for change. Ann Intern Med. 1991;114:142–143[ISI][Medline]
  98. Gottschalk A, Sostman HD, Coleman RE. Ventilation-perfusion scintigraphy in the PIOPED study. Part II. Evaluation of the scintigraphic criteria and interpretations. J Nucl Med. 1993;34:1119–1126[Abstract/Free Full Text]
  99. Sostman HD, Coleman RE, DeLong DM, Newman GE, Paine S. Evaluation of revised PIOPED criteria for ventilation perfusion scintigraphy in patients with suspected pulmonary embolism. Radiology. 1994;193:103–107[Abstract/Free Full Text]
  100. Hull RD, Hirsh J, Carter CJ. Diagnostic value of ventilation-perfusion lung scanning in patients with suspected pulmonary embolism. Chest. 1985;88:819–828[CrossRef][ISI][Medline]
  101. Stein PD, Hull RD, Saltzman HA, Pineo G. Strategy for diagnosis of patients with suspected acute pulmonary embolism. Chest. 1993;103:1553–1559[CrossRef][ISI][Medline]
  102. Van Beek EJR, Tiel-van Buul MMC, Büller HR, van Royen EA, ten Cate JW. The value of lung scintigraphy in the diagnosis of pulmonary embolism. Eur J Nucl Med. 1993;20:173–181[ISI][Medline]
  103. Ginsberg JS. Management of venous thromboembolism. N Engl J Med. 1996;335:1816–1828[Free Full Text]
  104. Bateman NT, Coakley AJ, Croft DN, Lyall JRW. Ventilation-perfusion lung scans for pulmonary embolism. Accuracy of reporting. Eur J Nucl Med. 1977;2:201–203[ISI][Medline]
  105. Hoey JR, Farrer PA, Rosenthall LJ, Spengler RF. Interobserver and intra-observer variability in lung scan reading in suspected pulmonary embolism. Clin Nucl Med. 1980;5:509–513
  106. Sullivan DC, Coleman RE, Mills SR, Ravin CE, Hedlund LW. Lung scan interpretation: effect of different observers and different criteria. Radiology. 1983;149:803–807[Abstract/Free Full Text]
  107. Lensing AWA, van Beek EJR, Demers C. Ventilation-perfusion lung scanning and the diagnosis of pulmonary embolism: improvement of observer agreement by the use of a lung segment reference chart. Thromb Haemost. 1992;68:245–249[ISI][Medline]
  108. Van Beek EJR, Tiel-van Buul MMC, Hoefnagel CA, Jagt HHT, van Royen EA. Reporting of perfusion-ventilation lung scintigraphy with the use of an anatomical lung segment chart—a prospective study. Nucl Med Commun. 1994;15:746–751[ISI][Medline]
  109. Kipper MS, Moser KM, Kortman KE, Ashburn WL. Longterm follow-up of patients with suspected pulmonary embolism and a normal lung scan. Chest. 1982;82:411–415[CrossRef][ISI][Medline]
  110. Hull RD, Raskob GE, Coates G, Panju AA. Clinical validity of a normal perfusion lung scan in patients with suspected pulmonary embolism. Chest. 1990;97:23–26[CrossRef][ISI][Medline]
  111. Van Beek EJR, Kuyer PMM, Schenk BE, Brandjes DPM, ten Cate JW, Büller HR. A normal perfusion lung scan in patients with clinically suspected pulmonary embolism: frequency and clinical validity. Chest. 1995;108:170–173[CrossRef][Medline]
  112. Cheely R, McCartney WH, Perry JR. The role of noninvasive tests versus pulmonary angiography in the diagnosis of pulmonary embolism. Am J Med. 1981;70:17–22[CrossRef][ISI][Medline]
  113. McBride K, LaMorte WW, Menzoian JO. Can ventilation-perfusion scans accurately diagnose acute pulmonary embolism? Arch Surg. 1986;121:754–757[Abstract]
  114. Hull RD, Raskob GE, Carter CJ. Pulmonary embolism in outpatients with pleuritic chest pain. Arch Intern Med. 1988;148:838–844[Abstract]
  115. Alderson PO, Biello DR, Sachariah KG, Siegel BA. Scintigraphic detection of pulmonary embolism in patients with obstructive pulmonary disease. Radiology. 1981;138:661–666[Abstract/Free Full Text]
  116. Spies WG, Burstein SP, Dillehay GL, Vogelzang RL, Spies SM. Ventilation-perfusion scintigraphy in suspected pulmonary embolism: correlation with pulmonary angiography and refinement of criteria for interpretation. Radiology. 1986;159:383–390[Abstract/Free Full Text]
  117. Gray HW, McKillop JH, Bessent RG, Fogelman I, Smith ML, Moran F. Lung scanning for pulmonary embolism: clinical and pulmonary angiographic correlations. Q J Med. 1990;77:1135–1150[ISI][Medline]
  118. McNeil BJ. A diagnostic strategy using ventilation-perfusion studies in patients suspected for pulmonary embolism. J Nucl Med. 1976;17:613–616[Abstract/Free Full Text]
  119. Fischer KC, McNeil BJ. The indeterminate lung scan: its characteristics and its association with pulmonary embolism. Eur J Nucl Med. 1979;4:49–53[ISI][Medline]
  120. Van Beek EJR, Reekers JA, Batchelor D, Brandjes DPM, Peeters FLM, Büller HR. Feasibility, safety and clinical utility of angiography in patients with suspected pulmonary embolism and non-diagnostic lung scan findings. Eur Radiol. 1996;6:415–419[ISI][Medline]
  121. Lesser BA, Leeper KV, Stein PD. The diagnosis of acute pulmonary embolism in patients with chronic obstructive pulmonary disease. Chest. 1992;102:17–22[Medline]
  122. Ludwig, JW, Heart and coronaries—the pioneering age, Rosenbusch, GOudkerk, MAmman, E, Radiology in medical diagnostics—evolution of X-ray applications 1895–1995. Oxford, Blackwell Science, 1995, 213, 24
  123. Dalen JE, Brooks HL, Johnson LW. Pulmonary angiography in acute pulmonary embolism: indications, techniques, and results in 367 patients. Am Heart J. 1971;81:175–185[CrossRef][ISI][Medline]
  124. Sasahara AA, Hyers TM, Cole CM. The urokinase pulmonary embolism trial. Circulation. 1973;47:1–108[Free Full Text]
  125. Bell WR, Simon TL. A comparative analysis of pulmonary perfusion scans with pulmonary angiograms. Am Heart J. 1976;92:700–706[CrossRef][ISI][Medline]
  126. Mills SR, Jackson DC, Older RA. The incidence, etiologies, and avoidance of complications of pulmonary angiography in a large series. Radiology. 1980;136:295–299[Abstract/Free Full Text]
  127. Stein PD, Athanasoulis C, Alavi A. Complications and validity of pulmonary angiography in acute pulmonary embolism. Circulation. 1992;85:462–468[Abstract/Free Full Text]
  128. Van Rooy WJJ, den Heeten GJ, Sluzewski M. Pulmonary embolism: diagnosis in 211 patients with use of selective pulmonary digital subtraction angiography with a flow-directed catheter. Radiology. 1995;195:793–797[Abstract/Free Full Text]
  129. Hudson ER, Smith TP, McDermott VG. Pulmonary angiography performed with iopamidol: complications in 1434 patients. Radiology. 1996;198:61–65[Abstract/Free Full Text]
  130. Van Beek EJR, Reekers JA, Batchelor D, Brandjes DPM, Peeters FLM, Büller HR. Feasibility, safety and clinical utility of angiography in patients with suspected pulmonary embolism and non-diagnostic lung scan findings. Eur Radiol. 1996;6:415–419[ISI][Medline]
  131. Zuckerman DA, Sterling KM, Oser RF. Safety of pulmonary angiography in the 1990s. J Vasc Intervent Radiology. 1996;7:199–205[ISI][Medline]
  132. Nilsson T, Carlsson A, Mare K. Pulmonary angiography: a safe procedure with modern contrast media and technique. Eur Radiol. 1998;8:86–89[CrossRef][ISI][Medline]
  133. Oudkerk M, van Beek EJR, Reekers JA. Pulmonary angiography: technique, indications and interpretations. Oudkerk M, van Beek EJR, ten Cate JW. Pulmonary Embolism. Berlin: Blackwell Science; 1999. p. 135–159
  134. Perlmutt LM, Braun SD, Newman GE, Oke EJ, Dunnick NR. Pulmonary arteriography in the high-risk patient. Radiology. 1987;162:187–189[Abstract/Free Full Text]
  135. Nicod P, Peterson K, Levine M. Pulmonary angiography in severe chronic pulmonary hypertension. Ann Intern Med. 1987;107:565–568[CrossRef][ISI][Medline]
  136. Grollman JH, Gyepes MT, Helmer E. Transfemoral selective bilateral pulmonary arteriography with a pulmonary artery seeking catheter. Radiology. 1970;96:102–104
  137. Van Beek EJR, Bakker AJ, Reekers JA. Interobserver variability of pulmonary angiography in patients with non-diagnostic lung scan results: conventional versus digital subtraction arteriography. Radiology. 1996;198:721–724[Abstract/Free Full Text]
  138. Saeed M, Braun SD, Cohan RH. Pulmonary angiography with iopamidol: patient comfort, image quality and hemodynamics. Radiology. 1987;165:345–349[Abstract/Free Full Text]
  139. Tajima H, Kumazaki T, Tajima N, Ebata K. Effect of iohexol and diatrizoate on pulmonary arterial pressure following pulmonary angiography. Acta Radiol Scand. 1988;Suppl 29:487–490
  140. Smit EMT, van Beek EJR, Bakker AJ, Reekers JA. A blind, randomized trial evaluating the hemodynamic effects of contrast media during pulmonary angiography for suspected pulmonary embolism—ioxaglate vs iohexol. Acad Radiol. 1995;2:609–613[CrossRef][ISI][Medline]
  141. Johnson MS, Stine SB, Shah H, Harris VJ, Ambrosius WT, Trerotola SO. Possible pulmonary embolus: evaluation with digital subtraction versus cut-film angiography— prospective study in 80 patients. Radiology. 1998;207:131–138[Abstract/Free Full Text]
  142. Hagspiel KD, Polak JF, Grassi CJ, Faitelson BB, Kandarpa K, Meyerovitz MF. Pulmonary embolism: comparison of cut-film and digital pulmonary angiography. Radiology. 1998;207:139–145[Abstract/Free Full Text]
  143. Piers DB, Verzijlbergen F, Westermann CJJ, Ludwig JW. A comparative study of intravenous digital subtraction angiography and ventilation perfusion scans in suspected pulmonary embolism. Chest. 1987;91:837–844[Medline]
  144. Musset D, Rosso J, Petiptretz P. Acute pulmonary embolism: diagnostic value of digital subtraction angiography. Radiology. 1986;166:455–459
  145. Pond GD, Ovitt TW, Capp MP. Comparison of conventional pulmonary angiography with intravenous digital subtraction angiography for pulmonary embolic disease. Radiology. 1983;147:345–350[Abstract/Free Full Text]
  146. Johnson BA, James AE. Oblique and selective pulmonary angiography in diagnosis of pulmonary embolism. Am J Roentgenol. 1973;118:801–808[Abstract]
  147. Bookstein JJ. Segmental arteriography in pulmonary embolism. Radiology. 1969;93:1007–1012[ISI][Medline]
  148. Hull RD, Hirsh J, Carter CJ. Pulmonary angiography, ventilation lung scanning, and venography for clinically suspected pulmonary embolism with abnormal perfusion lung scan. Ann Intern Med. 1983;98:891–899[ISI][Medline]
  149. Quinn MF, Lundell CJ, Klotz TA. Reliability of selective pulmonary arteriography in the diagnosis of pulmonary embolism. Am J Roentgenol. 1987;149:469–471[Abstract/Free Full Text]
  150. Oser RF, Zuckerman DA, Gutierrez FR, Brink JA. Anatomic distribution of pulmonary emboli at pulmonary angiography: implications for cross-sectional imaging. Radiology. 1996;199:31–35[Abstract/Free Full Text]
  151. Novelline RA, Baltarowich OH, Athanasoulis CA. The clinical course of patients with suspected pulmonary embolism and a negative pulmonary arterio-gram. Radiology. 1978;126:561–567[Abstract]
  152. Henry JW, Relyea B, Stein PD. Continuing risk of thromboemboli among patients with normal pulmonary angiograms. Chest. 1995;107:1375–1378[CrossRef][Medline]
  153. Remy-Jardin M, Remy J, Wattinne L, Giraud F. Central pulmonary thromboembolism: diagnosis with spiral volumetric CT with single-breath-hold technique— comparison with pulmonary angiography. Radiology. 1992;185:381–387[Abstract/Free Full Text]
  154. Teigen CL, Maus TP, Sheedy PF II, Johnson CM, Stanson AW, Welch TJ. Pulmonary embolism: diagnosis with electron-beam CT. Radiology. 1993;188:839–845[Abstract/Free Full Text]
  155. Van Rossum AB, Pattynama PMT, Tjin A. Pulmonary embolism: Validation of spiral CT-angiography in 124 patients. Radiology. 1996;201:467–470[Abstract/Free Full Text]
  156. Remy-Jardin M, Remy J, Artaud D, Deschildre F, Duhamel A. Peripheral pulmonary arteries: Optimization of the spiral CT acquisition protocol. Radiology. 1997;204:157–163[Abstract/Free Full Text]
  157. Kalender WA, Polacin A. Physical performance characteristics of spiral CT scanning. Med Phys. 1991;18:910–915[CrossRef][ISI][Medline]
  158. Remy-Jardin M, Remy J, Deschildre F. Diagnosis of pulmonary embolism with spiral CT: comparison with pulmonary angiography and scintigraphy. Radiology. 1996;200:699–706[Abstract/Free Full Text]
  159. Schnyder P, Meuli R, Wicky S, Mayor B. Injection techniques in helical CT of the chest. Eur Radiol. 1995;5:26–33
  160. Goodman LR, Curtin JJ, Mewissen MW. Detection of pulmonary embolism in patients with unresolved clinical and scintigraphic diagnosis: Helical CT versus angiography. Am J Roentgenol. 1995;164:1369–1374[Abstract/Free Full Text]
  161. Remy-Jardin M, Remy J, Cauvain O, Petyt L, Wannebroucq J, Beregi JP. Diagnosis of central pulmonary embolism with helical CT: role of two-dimensional multiplanar reformations. Am J Roentgenol. 1992;165:1131–1138
  162. Coche EC, Mueller NL, Kim K, Wiggs B, Mayo J. Acute pulmonary embolism: ancillary findings at spiral CT. Radiology. 1998;207:753–758[Abstract/Free Full Text]
  163. Herold CJ, Kontrus M, Ziesche G, Fleischmann D, Wegerle T, Huebsch. Evaluation of pulmonary embolism: value of 3D and multiplanar cine spiral CT angiography. Radiology. 1993;189:264
  164. Schwickert HC, Schweden FJ, Schild HH. Pulmonary arteries and lung parenchyma in chronic pulmonary embolism: preoperative and postoperative CT findings. Radiology. 1994;191:351–357[Abstract/Free Full Text]
  165. Mayo JR, Remy-Jardin M, Müller NL. Pulmonary embolism: prospective comparison of spiral CT with ventilation/perfusion scintigraphy. Radiology. 1997;205:447–452[Abstract/Free Full Text]
  166. Drucker E, Rivitz M, Shepard J. Acute pulmonary embolism: assessment of helical CT for diagnosis. Radiology. 1998;209:235–241[Abstract/Free Full Text]
  167. Garg K, Welsh C, Feyerabend A. Pulmonary embolism: diagnosis with spiral CT and ventilation-perfusion scanning—correlation with pulmonary angiographic results or clinical outcome. Radiology. 1998;208:201–208[Abstract/Free Full Text]
  168. Kim K, Müller NL, Mayo JR. Clinically suspected pulmonary embolism: utility of spiral-CT. Radiology. 1999;210:693–697[Abstract/Free Full Text]
  169. Baile EM, Mayo JR, King GG, Muller NL, Coche EC, Pare PD. Contrast-enhanced spiral-CT is comparable to pulmonary angiography for the diagnosis of pulmonary embolism. Radiology. 1999;213:127
  170. Van Erkel AR, van Rossum AB, Bloeum JL. Spiral CT angiography for suspected pulmonary embolism: cost-effectiveness analysis. Radiology. 1996;201:29–36[Abstract/Free Full Text]
  171. Ferretti GR, Bosson J-L, Buffaz P-D. Acute pulmonary embolism: role of helical CT in 164 patients with intermediate probability at V/Q scintigraphy and normal results at duplex US of the legs. Radiology. 1998;205:453–458
  172. Krestan CR, Klein N, Kreuzer S, Minar E, Janeta J, Herold CJ. Value of a negative spiral-CT angiography in patients with suspected acute PE: retrospective analysis of PE recurrence and outcome. Eur Radiol. 2000;:
  173. Goodman LR, Lipchik RJ. Diagnosis of acute pulmonary embolism: time for a new approach. Radiology. 1996;199:25–27[Free Full Text]
  174. Janata-Schwatczek K, Weiss K, Riezinger I, Bankier A, Domanovits H, Seidler D. Pulmonary embolism II: diagnosis and treatment. Sem Thromb Hemostas. 1996;22:33–52[ISI][Medline]
  175. Curtin JJ, Mewissen MW, Crain MR, Lipchik RJ. Post-contrast CT in the diagnosis and assessment of response to thrombolysis in massive pulmonary embolism. J Comput Assist Tomogr. 1994;18:133–135[ISI][Medline]
  176. Remy-Jardin M, Louvegny S, Remy J. Acute central thromboembolic disease: post-therapeutic follow-up with spiral CT angiography. Radiology. 1997;203:173–180[Abstract/Free Full Text]
  177. Kasper W, Konstantinides S, Geibel A. Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol. 1997;30:1165–1171[Abstract]
  178. Nazeyrollas P, Metz D, Jolly D. Use of transthoracic Doppler echocardiography combined with clinical and electrocardiographic data to predict acute pulmonary embolism. Eur Heart J. 1996;17:779–786[Abstract/Free Full Text]
  179. McConnell MV, Solomon SD, Rayan ME, Come PC, Goldhaber SZ, Lee RT. Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism. Am J Cardiol. 1996;78:469–473[CrossRef][ISI][Medline]
  180. Torbicki A, Kurzyna M, Ciurzynski M. Proximal pulmonary emboli modify right ventricular ejection pattern. Eur Respir J. 1999;13:616–621[Abstract]
  181. Wolfe MW, Lee RT, Feldstein ML, Parker JA, Come PC, Goldhaber SZ. Prognostic significance of right ventricular hypokinesis and perfusion lung scan defects in pulmonary embolism. Am Heart J. 1994;127:1371–1375[CrossRef][ISI][Medline]
  182. Cheriex EC, Sreeram N, Eussen YF, Pieters FA, Wellens HJ. Cross sectional Doppler echocardiography as the initial technique for the diagnosis of acute pulmonary embolism. Br Heart J. 1994;72:52–57[Abstract/Free Full Text]
  183. Kasper W, Geibel A, Tiede N. Distinguishing between acute and subacute massive pulmonary embolism by conventional and Doppler echocardiography. Br Heart J. 1993;70:352–356[Abstract/Free Full Text]
  184. Wittlich N, Erbel R, Eichler A. Detection of central pulmonary artery thromboemboli by transesophageal echocardiography in patients with severe pulmonary embolism. J Am Soc Echocardiogr. 1992;5:515–524[Medline]
  185. Pruszczyk P, Torbicki A, Pacho R. Noninvasive diagnosis of suspected severe pulmonary embolism: transesophageal echocardiography vs spiral CT. Chest. 1997;112:722–728[ISI][Medline]
  186. Patel JJ, Chandrasekaran K, Maniet AR. Impact of the incidental diagnosis of clinically unsuspected central pulmonary artery thromboembolism in treatment of critically ill patients. Chest. 1994;105:986–990[Medline]
  187. Krivec B, Voga G, Zuran I. Diagnosis and treatment of shock due to massive pulmonary embolism: approach with transesophageal echocardiography and intrapulmonary thrombolysis. Chest. 1997;112:1310–1316[Medline]
  188. Van der Wouw PA, Koster RW, Delemarre BJ. Diagnostic accuracy of transesophageal echocardiography during cardiopulmonary resuscitation. J Am Coll Cardiol. 1997;30:780–783[Abstract]
  189. Torbicki A, Pasierski T, Uchman B, Miskiewicz Z. Right atrial mobile thrombi: two-dimensional echocardiographic diagnosis and clinical outcome. Cor Vasa. 1987;29:293–303[ISI][Medline]
  190. Chapoutot L, Nazeyrollas P, Metz D. Floating right heart thrombi and pulmonary embolism: diagnosis, outcome and therapeutic management. Cardiology. 1996;87:169–174[ISI][Medline]
  191. Kasper W, Geibel A, Tiede N, Just H. Patent foramen ovale in patients with haemodynamically significant pulmonary embolism. Lancet. 1992;340:561–564[CrossRef][ISI][Medline]
  192. Ribeiro A, Lindmarker P, Johnsson H, Juhlin-Dannfelt A, Jorfeldt L. Pulmonary embolism: one-year follow-up with echocardiography doppler and five-year survival analysis. Circulation. 1999;99:1325–1330[Abstract/Free Full Text]
  193. Porter TR, Taylor DO, Fields J. Direct in vivo evaluation of pulmonary arterial pathology in chronic congestive heart failure with catheter-based intravascular ultrasound imaging. Am J Cardiol. 1993;71:754–757[CrossRef][ISI][Medline]
  194. Gorge G, Erbel R, Schuster S. Intravascular ultrasound in diagnosis of acute pulmonary embolism. Lancet. 1991;337:623–624[Medline]
  195. Gorge G, Schuster S, Ge J. Intravscular ultrasound in patients with acute pulmonary embolism after treatment with intravenous urokinase and high-dose heparin. Heart. 1997;77:73–77[Abstract/Free Full Text]
  196. Ricou F, Nicod PH, Moser KM. Catheter-based intravascular ultrasound imaging of chronic thromboembolic pulmonary disease. Am J Cardiol. 1991;67:749–752[CrossRef][ISI][Medline]
  197. Sevitt S, Gallagher NG. Venous thrombosis and pulmonary embolism: a clinicopathologic study in injured and burned patients. Br J Surg. 1961;48:475–482[ISI][Medline]
  198. Hull RD, Hirsh J, Carter C. Diagnostic efficacy of impedance plethysmography for clinically suspected deep-vein thrombosis. Ann Intern Med. 1985;102:21–28[ISI][Medline]
  199. Ginsberg JS, Wells PS, Hirsh J. Reevaluation of the sensitivity of impedance plethysmography for the detection of proximal deep vein thrombosis. Arch Intern Med. 1994;154:1930–1933[Abstract]
  200. Heijboer H, Büller HR, Lensing AWA, Turpie AGG, Colly LP, ten Cate JW. A comparison of real-time compression ultrasonography with impedance plethysmography for the diagnosis of deep-vein thrombosis in symptomatic outpatients. N Engl J Med. 1993;329:1365–1369[Abstract/Free Full Text]
  201. Becker DM, Philbrick JT, Abbitt PL. Real-time ultrasonography for the diagnosis of lower extremity deep venous thrombosis. The wave of the future? Arch Intern Med. 1989;149:1731–1734[CrossRef][ISI][Medline]
  202. Lensing AWA, Prandoni P, Brandjes D. Detection of deep-vein thrombosis by real-time B-mode ultrasonography. N Engl J Med. 1989;320:342–345[Abstract]
  203. Stein PD, Henry JW, Gopalakrishnan D, Relyea B. Asymmetry of the calves in the assessment of patients with suspected acute pulmonary embolism. Chest. 1995;107:936–939[Medline]
  204. Turkstra F, Kuijer PMM, van Beek EJR, Brandjes DPM, ten Cate JW, Büller HR. Diagnostic utility of ultrasonography of leg veins in patients suspected of having pulmonary embolism. Ann Intern Med. 1997;126:775–781[Abstract/Free Full Text]
  205. Wells PS, Lensing AWA, Davidson BL, Prins MH, Hirsh J. Accuracy of ultrasound for the diagnosis of deep venous thrombosis in asymptomatic patients after orthopedic surgery. Ann Intern Med. 1995;122:47–53[Abstract/Free Full Text]
  206. Killewich LA, Bedford GR, Beach KW, Strandness DE. Diagnosis of deep venous thrombosis. A prospective study comparing duplex scaning to contrast venography. Circulation. 1989;79:810–814[Abstract/Free Full Text]
  207. Perrier A, Desmarais S, Goehring C. D-dimer testing for suspected pulmonary embolism in outpatients. Am J Respir Crit Care Med. 1997;156:492–496[Abstract/Free Full Text]
  208. Smith LL, Conrad I, Sirr S. Pulmonary embolism: confirmation with venous duplex US as adjunct to lung scanning. Radiology. 1994;191:143–147[Abstract/Free Full Text]
  209. Quinn RJ, Nour R, Butler SP. Pulmonary embolism in patients with intermediate probability lung scans: diagnosis with Doppler venous US and D-Dimer measurement. Radiology. 1994;190:509–511[Abstract/Free Full Text]
  210. Beecham RP, Dorfman GS, Cronan JJ, Spearman MP, Murphy TP, Scola FH. Is bilateral lower extremity compression sonography useful and cost-effective in the evaluation of suspected pulmonary embolism? Am J Roentgenol. 1993;161:1289–1292[Abstract/Free Full Text]
  211. Oudkerk M, van Beek JR, van Putten WLJ, Büller HR. Cost-effectiveness analysis of various strategies in the diagnostic management of pulmonary embolism. Arch Intern Med. 1993;153:947–954[Abstract]
  212. Hull RD, Feldstein W, Stein PD, Pineo GF. Cost-effectiveness of pulmonary embolism diagnosis. Arch Intern Med. 1996;156:68–72[Abstract]
  213. Perrier A, Buswell L, Bounameaux H. Cost-effectiveness of noninvasive diagnostic aids in suspected pulmonary embolism. Arch Intern Med. 1997;157:2309–2316[Abstract]
  214. Hull RD, Raskob GE, Ginsberg JS. A noninvasive strategy for the treatment of patients with suspected pulmonary embolism. Arch Intern Med. 1994;154:289–297[Abstract]
  215. Lagerstedt CI, Fagher BO, Olsson CG, Öqvist BW. Need for long-term anticoagulant treatment in symptomatic calf-vein thrombosis. Lancet. 1985;2:515–518[ISI][Medline]
  216. Kakkar VV, Flanc C, Howe CT, Clarke MB. Natural history of postoperative deep-vein thrombosis. Lancet. 1969;2:230–232[CrossRef][ISI][Medline]
  217. Bounameaux H, de Moerloose P, Perrier A, Miron MJ. D-dimer testing in suspected venous thromboembolism: an update. Q J Med. 1997;90:437–442
  218. Righini, M, Goehring, C, Bounameaux, H, Perrier, A, Influence of age on performances of common diagnostic tests in suspected pulmonary embolism, Am J Med 2000
  219. Miron MJ, Perrier A, Bounameaux H. Contribution of noninvasive evaluation to the diagnosis of pulmonary embolism in hospitalized patients. Eur Respir J. 1999;13:1365–1370[Abstract]
  220. Ginsberg JS, Wells PS, Kearon C. Sensitivity and specificity of a rapid whole-blood assay for D-dimer in the diagnosis of pulmonary embolism. Ann Intern Med. 1998;129:1006–1011[Abstract/Free Full Text]
  221. Bounameaux H, de Moerloose P, Perrier A, Reber G. Plasma measurement of D-dimer as diagnostic aid in suspected venous thromboembolism: an overview. Thromb Haemost. 1994;71:1–6[ISI][Medline]
  222. Van Beek EJR, van den Ende B, Berckmans RJ. A comparative analysis of D-dimer assays in patients with clinically suspected pulmonary embolism. Thromb Haemost. 1993;70:408–413[ISI][Medline]
  223. De Moerloose P, Desmarais S, Bounameaux H. Contribution of a new, rapid, individual and quantitative automated D-dimer ELISA to exclude pulmonary embolism. Thromb Haemost. 1996;75:11–13[ISI][Medline]
  224. Oger E, Leroyer C, Bressollette L. Evaluation of a new, rapid, and quantitative D-Dimer test in patients with suspected pulmonary embolism. Am J Respir Crit Care Med. 1998;158:65–70[Abstract/Free Full Text]
  225. Reber G, Bounameaux H, Perrier A, de Moerloose P. Performances of a new, rapid amnd automated microlatex D-dimer assay for the exclusion of pulmonary embolism in symptomatic outpatients. Thromb Haemost. 1998;80:719–720[ISI][Medline]
  226. Ginsberg JS, Wells PS, Brill-Edwards P. Application of a novel and rapid whole blood assay for D-Dimer in patients with clinically suspected pulmonary embolism. Thromb Haemost. 1995;73:379–386
  227. Turkstra F, van Beek JR, ten Cate JW, Büller HR. Reliable rapid blood test for the exclusion of venous thromboembolism in symptomatic outpatients. Thromb Haemost. 1996;76:9–11[ISI][Medline]
  228. Carson JL, Kelley MA, Duff A, Palevitch M. The clinical course of pulmonary embolism. N Engl J Med. 1992;326:1240–1245[Abstract]
  229. Miron MJ, Perrier A, Bounameaux H. Contribution of noninvasive evaluation to the diagnosis of pulmonary embolism in hospitalized patients. J Gen Intern Med. 1998;13:20
  230. McIntyre KM, Sasahara AA. Determinants of right ventricular function and hemodynamics after pulmonary embolism. Chest. 1974;65:534–543[CrossRef][ISI][Medline]
  231. Azarian R, Wartski M, Collignon MA. Lung perfusion scans and hemodynamics in acute and chronic pulmonary embolism. J Nucl Med. 1997;38:980–983[Abstract/Free Full Text]
  232. Molloy WD, Lee KY, Girling L, Schick GU, Prewitt RM. Treatment of shock in a canine model of pulmonary embolism. Am Rev Respir Dis. 1984;130:870–874[ISI][Medline]
  233. Adams JE, Siegel BA, Goldstein ML. Elevation of CK-MB following pulmonary embolism. Chest. 1992;101:1203–1206[CrossRef][ISI][Medline]
  234. Ramirez-Rivera A, Gutierrez-Fajardo P, Jerjes-Sanchez C. Acute right myocardial infarction without significant obstructive coronary lesions secondary to massive pulmonary embolism (Abstr). Chest. 1993;104:80S
  235. Belenkie I, Dani R, Smith ER, Tyberg JV. Ventricular interaction during experimental acute pulmonary embolism. Circulation. 1988;78:761–768[Abstract/Free Full Text]
  236. Belenkie I, Dani R, Smith ER, Tyberg JV. Effects of volume loading during experimental acute pulmonary embolism. Circulation. 1989;80:178–188[Abstract/Free Full Text]
  237. Ozier Y, Dubourg O, Farcot JC, Bazin M, Jardin F, Margairaz A. Circulatory failure in acute pulmonary embolism. Intensive Care Med. 1984;10:91–97[CrossRef][ISI][Medline]
  238. Mercat A, Diehl JL, Meyer G, Teboul J-L, Sors H. Hemodynamic effects of fluid loading in acute massive pulmonary embolism. Crit Care Med. 1999;27:540–544[CrossRef][ISI][Medline]
  239. Jardin F, Gurdjian F, Margairaz A. Effet délétère de l'isoprénaline au cours d'une embolie pulmonaire massive. Nouv Presse Med. 1977;6:1878[ISI][Medline]
  240. Molloy DW, Lee KY, Jones D, Penner B, Prewitt RM. Effects of noradrenaline and isoproterenol on cardiopulmonary function in a canine model of acute pulmonary hypertension. Chest. 1985;88:432–435[CrossRef][ISI][Medline]
  241. Ducas J, Stitz M, Gu S, Schick U, Prewitt RM. Pulmonary vascular pressure-flow characteristics: effects of dopamine before and after pulmonary embolism. Am Rev Respir Dis. 1992;148:307–312
  242. Jardin F, Genevray B, Brun-Ney D, Margairaz A. Dobutamine. A hemodynamic evaluation in pulmonary embolism shock. Crit Care Med. 1985;13:1009–1012[ISI][Medline]
  243. Boulain T, Lanotte R, Legras A. Efficacy of epinephrine therapy in shock complicating pulmonary embolism. Chest. 1993;104:300–302[Medline]
  244. Delcroix M, Melot C, Lejeune P, Leeman M, Naeije R. Effects of vasodilators on gas exchange in acute canine embolic pulmonary hypertension. Anesthesiology. 1990;72:77–84[ISI][Medline]
  245. Huet Y, Brun-Buisson C, Lemaire F, Teisseire B, Lhoste F, Rapin M. Cardiopulmonary effects of ketanserin infusion in human pulmonary embolism. Am Rev Respir Dis. 1987;135:114–117[ISI][Medline]
  246. Böttiger BW, Motsch J, Dörsam J. Inhaled nitric oxide selectively decreases pulmonary artery pressure and pulmonary vascular resistance following acute massive pulmonary microembolism in piglets. Chest. 1996;110:1041–1047[CrossRef][ISI][Medline]
  247. Capellier G, Jacques T, Balay P. Inhaled nitric oxide in patients with pulmonary embolism. Intensive Care Med. 1997;1089:
  248. Circulation. 1973;47:1–130[Free Full Text]
  249. Jardin F, Gurdjian F, Desfonds P, Fouilladieu JL, Margairaz A. Hemodynamic factors influencing arterial hypoxemia in massive pulmonary embolism with circulatory failure. Circulation. 1979;59:909–912[Abstract/Free Full Text]
  250. Alpert JS, Smith R, Carlson J. Mortality in patients treated for pulmonary embolism. JAMA. 1976;236:1477–1480[Abstract]
  251. Goldhaber SZ, Haire WD, Feldstein ML. Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion. Lancet. 1993;341:507–511[CrossRef][ISI][Medline]
  252. Konstantinides S, Geibel A, Olschewski M. Association between thrombolytic treatment and the prognosis of hemodynamically stable patients with major pulmonary embolism. Circulation. 1997;96:882–888[Abstract/Free Full Text]
  253. Dalla-Volta S, Palla A, Santolicandro A. PAIMS 2: alteplase combined with heparin versus heparin in the treatment of acute pulmonary embolism. Plasminogen activator italian multicenter study 2. J Am Coll Cardiol. 1992;20:520–526[Abstract]
  254. Tibbutt DA, Davies JA, Anderson JA. Comparison by controlled clinical trial of streptokinase and heparin in treatment of life-threatening pulmonary embolism. Br Med J. 1974;1:343–347[ISI][Medline]
  255. Stein PD, Hull RD, Raskob G. Risks for major bleeding from thrombolytic therapy in patients with acute pulmonary embolism. Ann Intern Med. 1994;121:313–317[Abstract/Free Full Text]
  256. Mikkola KM, Patel SR, Parker JA, Grodstein F, Goldhaber SZ. Increasing age is a major risk factor for hemorrhagic complications after pulmonary embolism thrombolysis. Am Heart J. 1997;134:69–72[CrossRef][ISI][Medline]
  257. Meyer G, Charbonnier B, Stern M, Brochier M, Sors H. Thrombolysis in acute pulmonary embolism. Julian DG, Kubler W, Norris RM, Swan HJ, Collen D, Verstraete M. Thrombolysis in cardiovascular disease. New-York: Marcel Dekker; 1989. p. 337–360
  258. Meyer G, Gisselbrecht M, Diehl JL, Journois D, Sors H. Incidence and predictors of major hemorrhagic complications from thrombolytic therapy in patients with massive pulmonary embolism. Am J Med. 1998;105:472–477[CrossRef][ISI][Medline]
  259. Kanter DS, Mikkola KM, Patel SR, Parker JA, Goldhaber SZ. Thrombolytic therapy for pulmonary embolism. Frequency of intracranial hemorrhage and associated risk factors. Chest. 1997;111:1241–1245[CrossRef][ISI][Medline]
  260. Levine M, Hirsh J, Weitz J. A randomized trial of a single bolus dosage regimen of recombinant tissue plasminogen activator in patients with acute pulmonary embolism. Chest. 1990;98:1473–1479[CrossRef][ISI][Medline]
  261. Chest. 1990;97:528–533[CrossRef][ISI][Medline]
  262. Ly B, Arnesen H, Eie H, Hol R. A controlled clinical trial of streptokinase and heparin in the treatment of major pulmonary embolism. Acta Med Scand. 1978;203:465–470[ISI][Medline]
  263. Jerjes-Sanchez C, Ramirez-Rivera A, De Lourdes Garcia M. Streptokinase and heparin versus heparin alone in massive pulmonary embolism: A randomized controlled trial. J Thromb Thrombolys. 1995;2:227–229[Medline]
  264. Goldhaber SZ, Heit J, Sharma GVRK. Randomised controlled trial of recombinant tissue plasminogen activator versus urokinase in the treatment of acute pulmonary embolism. Lancet. 1988;2:293–298[ISI][Medline]
  265. Meyer G, Sors H, Charbonnier B. Effects of intravenous urokinase versus alteplase on total pulmonary resistance in acute massive pulmonary embolism: A European multicenter double-blind trial. J Am Coll Cardiol. 1992;19:239–245[Abstract]
  266. Sors H, Pacouret G, Azarian R, Meyer G, Charbonnier B, Bassand JP, Simonneau G. Hemodynamic effects of bolus versus two hour infusion of alteplase in acute massive pulmonary embolism. A randomized controlled multicenter trial. Chest. 1994;106:712–717[CrossRef][ISI][Medline]
  267. Goldhaber SZ, Agnelli G, Levine MN. Reduced dose bolus alteplase vs conventional alteplase infusion for pulmonary embolism thrombolysis. An international multicenter randomized trial. Chest. 1994;106:718–724[CrossRef][ISI][Medline]
  268. Meneveau N, Schiele F, Metz D. Comparative efficacy of a two hour regimen of streptokinase versus alteplase in acute massive pulmonary embolism: immediate clinical and hemodynamic outcome and one-year follow-up. J Am Coll Cardiol. 1998;32:1057–1063 <