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Early Systolic Notching and Pulmonary Embolism
A prospective multicenter study conducted across four academic emergency departments in Turkey evaluated the diagnostic accuracy of early systolic notching (ESN) in emergency department patients. Among the 183 patients included, 52.5% were diagnosed with pulmonary embolism (PE), while 19.7% exhibited the ESN finding. ESN demonstrated a sensitivity of 34% (95% CI: 25–45%) and a specificity of 97% (95% CI: 90–99%) for PE. Sensitivity increased to 69% in patients classified as high or intermediate-high risk. Overall, ESN exhibits moderate to high specificity but low sensitivity, consistent with other sonographic signs of PE. Notably, ESN may also be present in patients with chronic thromboembolic disease secondary to prior pulmonary hypertension.
How to Obtain ESN
To detect ESN, acquire a parasternal short axis view at the base of the heart to visualize the right ventricular outflow tract and pulmonic valve. Position the pulse wave Doppler gate just proximal to the pulmonic valve, with the cursor traversing the outflow tract. ESN is characterized by a sharp systolic spike with a notch, followed by a dome-shaped waveform
References
Aslaner MA, Karbek Akarca F, Aksu ?H, Yazla M, Can Ö, Ku? G, Çelik A, Özkan S, ?bze S, Yamano?lu A, Yaz?c? MM, Yürüktümen Ünal A, Demircan A. Diagnostic Accuracy of Early Systolic Notching in Pulmonary Embolism. J Ultrasound Med. 2022 Mar;41(3):637-644. doi: 10.1002/jum.15744.