Regional right ventricular dysfunction in acute
pulmonary embolism and right ventricular
Franco Casazza), Amedeo Bongarzoni, Angela Capozi,
Division of Cardiology, San Carlo Borromeo Hospital, via Pio 2(, n 3, 20153 Milan, Italy
Received 14 April 2004; received in revised form 14 April 2004; accepted 2 June 2004
to a severe hypokinesia of the mid-free wall (‘McConnell sign’) has been considered
a distinct echocardiographic pattern of acute pulmonary embolism.
To evaluate the clinical utility of the ‘McConnell sign’ in the bedside
diagnostic work-up of patients presenting to the Emergency Department with an
acute right ventricular dysfunction due to pulmonary embolism or right ventricular
Among 201 patients, consecutively selected from our clinical database
and diagnosed as having massive or submassive pulmonary embolism or right ven-
tricular infarction, 161 were suitable for an echocardiographic review of regional
right ventricular contraction and were included in the study. There were 107 cases
with pulmonary embolism (group 1) and 54 cases with right ventricular infarction
(group 2). All echocardiographic studies were randomly examined by two experi-
enced and independent echocardiographers, blinded to the patient diagnosis and
without Doppler informations.
The McConnell sign was detected in 75 of 107 patients in group 1 (70%)
and in 36 of 54 patients in group 2 (67%); the finding was absent in 32 cases in group
1 and in 18 cases in group 2 (P ¼ 0:657). The sensitivity, specificity, positive and
negative predictive values of the McConnell sign for the diagnosis of pulmonary
embolism were respectively 70, 33, 67 and 36%.
the McConnell sign cannot be considered a specific marker of pulmonary embolism.
ª 2004 The European Society of Cardiology. Published by Elsevier Ltd. All rights
A normally contracting right ventricular apex associated
Right ventricular wall
)Corresponding author. via Nikolajevka 12, 20152, Milan, Italy. Tel.: D39-2-4022-2943.
E-mail address: firstname.lastname@example.org (F. Casazza).
Eur J Echocardiography (2005) 6, 11e14
1525-2167/$30 ª 2004 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.