A system for diagnosing acute pulmonary thromboembolism using a non-dilated pulmonary artery as a diagnostic sign

Abstract

A system (100) for diagnosing acute pulmonary thromboembolism using a non-dilated pulmonary artery as a diagnostic sign, comprising: a transthoracic echocardiography unit (102) configured to generate echocardiographic images of cardiac structures; a measuring unit (104) configured to measure the dimensions of the right atrium, the right ventricle and the main pulmonary artery from the echocardiographic images; a comparison unit (106) configured to compare the diameter of the main pulmonary artery with the diameter of the ascending aorta to determine the dilation status of the pulmonary artery; a diagnostic sign recognition unit (108) configured to identify an SRC sign characterized by the presence of a non-dilated main pulmonary artery with a dilated right atrium and right ventricle; and a diagnostic output unit (110) configured to generate a diagnostic indication for acute pulmonary thromboembolism based on the presence of the SRC sign.

Description

FIELD OF THE INVENTIONThe present disclosure relates to a system for detecting acute pulmonary thromboembolism, more particularly, to a system for diagnosing acute pulmonary thromboembolism using an unexpanded pulmonary artery as a diagnostic sign.BACKGROUND OF THE INVENTIONPulmonary thromboembolisms (PTE) are considered to be the third most common cause of cardiovascular deaths. Annual incidence is 39-115 per 100,000 infants, mortality rate is nearly 30% without treatment. Rapid and accurate diagnosis is critical because almost one third of the patients die within a few hours of the occurrence of the first symptoms.Current diagnostic systems are based on computed tomography pulmonaryis angiography (CTPA) as a gold standard. However, in hemodynamically unstable patients, CTPA may not be feasible. Transthoracic echocardiography (TTE) serves as a portable diagnostic instrument at the hospital bed. However, the echocardiograph characters present are not specific enough to distinguish acute PTE from other causes of right heart challenge such as chronic obstructive pulmonary disease, atrial septum defects, or cardiomyopathy.Conventional TTE-based diagnostic systems typically identify dilation of the right atrium and ventricle as indicators of a PTE. However, these findings are not sufficient for definitive diagnosis because of their non-specificity. There is a need for diagnostic systems that provide more specific and reliable echocardiography markers for acute PTE detection.Therefore, there is a need for an improved diagnostic system that utilizes a novel echocardiograph sign to improve diagnostic accuracy, enable faster identification at the hospital bed, and effectively distinguish acute PTE from chronic right heart disease.SUMMARY OF THE INVENTIONThe present disclosure relates to a system for diagnosing acute pulmonary thromboembolism using a non-augmented pulmonary artery as a diagnostic sign. The present invention provides an acute pulmonary thromboembolism diagnostic system that utilizes a novel echocardiograph sign, the so-called SRC sign. This is characterized by a non-expanded main pulmonary artery in combination with an expanded right atrium and right ventricle. The system uses transthoracic echocardiography to acquire heart images, measure chamber dimensions, compare pulmonary artery and aorta diameters, and automatically recognize the SRC sign. This generates highly specific diagnostic instructions for acute PTE with 100% specificity and a positive prediction value.The present disclosure aims to provide a system for diagnosing acute pulmonary thromboembolism that uses a non-expanded pulmonary artery as a diagnostic sign. The system comprises: a transthoracic echocardiograph for generating echocardiograph images of heart structures; a measurement unit for measuring dimensions of the right atrium, the right ventricle, and the main pulmonary artery from the echocardiograph images; a comparison unit for comparing the diameter of the main pulmonary artery with the diameter of the ascending aorta to determine the dilation status of the pulmonary artery; a diagnostic sign recognition unit for identifying an SRC sign characterized by the presence of an unexpanded right atrium main pulmonary artery and an expanded right ventricle; and a diagnostic output unit for generating a diagnostic indication for acute pulmonary thromboembolism based on the presence of the SRC sign.An object of the present disclosure is to provide an acute pulmonary thromboembolism diagnostic system that uses a non-expanded pulmonary artery as a diagnostic sign.Another object of the present disclosure is to provide a diagnostic system that achieves higher diagnostic accuracy in acute pulmonary thromboembolism by identifying a new echocardiography sign with 100% specificity.Another object of the present disclosure is to develop a system that enables rapid diagnosis of an acute hospital bed PTE using readily available transthoracic echocardiographs, thus facilitating timely clinical decision making in emergency situations.Another object of the present disclosure is to provide a diagnostic system that can effectively distinguish acute pulmonary thromboembolism from other causes of right heart stress, including chronic obstructive pulmonary disease, cardiomyopathy, and innate heart failure.Another object of the present disclosure is to provide a system that reduces the dependence on computed tomographic pulmonaryis angiography for PTE diagnosis, particularly in hemodynamically unstable patients where CTPA may not be feasible.In order to further clarify the advantages and features of the present disclosure, the invention will be explained in more detail with reference to specific embodiments that are illustrated in the accompanying drawings. This drawing shows only typical embodiments of the invention and should therefore not be considered as limiting its scope. The invention will be described and explained in more detail with reference to the accompanying drawings.BRIEF DESCRIPTION OF THE FIGUREThese and other features, aspects, and advantages of the present disclosure will become more fully understood when the following detailed description is read with reference to the accompanying drawings, in which like characters represent like parts throughout. The following applies here: FIG. 1 is a block diagram of a system for diagnosing acute pulmonary thromboembolism using an unexpanded pulmonary artery as a diagnostic sign according to an embodiment of the present disclosure.Those skilled in the art will also appreciate that the elements in the drawing are shown for simplicity and are not necessarily to scale. For example, the flowcharts illustrate the method using the key steps to improve understanding of aspects of the present disclosure. Also, as for the construction of the apparatus, individual or plural components of the apparatus may be represented by conventional symbols in the drawing. The drawing may only show the specific details relevant to understanding the embodiments of the present disclosure so as not to obscure the drawing with details readily apparent to those skilled in the art after the present description.DETAILED DESCRIPTION:In order to promote an understanding of the principles of the invention, reference will now be made to the embodiment illustrated in the drawings and will be described in an comprehensible manner. However, the scope of the invention is not limited thereby. Changes and further modifications of the illustrated system, as well as further applications of the principles of the invention, are possible, as would normally occur to a person skilled in the art.It will be understood by those skilled in the art that the foregoing general description and the following detailed description are exemplary and explanatory of the invention and are not intended to be limiting thereof.References throughout this specification to "one aspect," "another aspect," or similar language mean that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment of the present disclosure. Thus, the phrases "in one embodiment," "in another embodiment," and similar phrases in this specification may or may not refer to the same embodiment.The terms "comprises," "comprising," or other variations thereof are intended to cover a non-exclusive inclusion, such that a process or method comprising a list of steps may include not only those steps, but also other steps not expressly listed or inherent in that process or method. Likewise, the phrase "comprises... for" one or more devices, subsystems, elements, structures, or components does not exclude, without further limitations, the existence of other devices, subsystems, elements, structures, components, or additional devices, subsystems, elements, structures, or components.Unless otherwise defined, all technical and scientific terms used herein have the same meaning as understood by one of ordinary skill in the art. The systems, methods, and examples provided herein are for illustrative purposes only and are not to be considered limiting.Embodiments of the present disclosure will be described in detail below with reference to the accompanying drawings.FIG. 1 shows a block diagram of a system (100) for diagnosing acute pulmonary thromboembolism using a non-augmented pulmonary artery as a diagnostic sign according to an embodiment of the present disclosure.Referring to FIG. 1, the system (100) includes: a transthoracic echocardiograph unit (102) configured to generate echocardiograph images of heart structures; a measurement unit (104) configured to measure dimensions of the right atrium, the right ventricle, and the main pulmonary artery from the echocardiograph images; a comparison unit (106) configured to compare the diameter of the main pulmonary artery with the diameter of the ascending aorta to determine the dilation status of the pulmonary artery; a diagnostic sign recognition unit (108) configured to identify an SRC sign characterized by the presence of a non-dilation main pulmonary artery with dilation right atrium and dilation right ventricle; and a diagnostic output unit (110) configured to generate a diagnostic acute pulmonary thromboembolism indication based on the presence of the SRC sign.In one embodiment, the transthoracic echocardiograph unit (102) is configured to capture images using standard echocardiograph views, including a four-chamber apical view and a short-axis parasternal view.In one embodiment, the measurement unit (104) is configured to determine dilation of the right atrium when the area of the right atrium exceeds 18 cm 2.In one embodiment, the sensing unit (104) is configured to determine dilation of the right ventricle when the diameter of the right ventricle at the base exceeds 42 mm, in the middle exceeds 35 mm, and in the longitudinal direction exceeds 86 mm.In one embodiment, the comparison unit (106) is configured to calculate a ratio between the diameter of the main pulmonary artery and the diameter of the ascending aorta, wherein a ratio of 1 or less is indicative of a non-expanded pulmonary artery.In one embodiment, the system (100) also comprises a pulmonary artery pressure evaluation unit (112) configured to calculate the systolic pulmonary artery pressure from the jet velocity in tricuspid insufficiency.In one embodiment, the system (100) also comprises a right ventricular function evaluation unit (114) configured to evaluate a right ventricular malfunction from systolic excision measurements in the tricuspid ring plane and fractional change in area calculations.In one embodiment, the diagnostic sign detection unit (108) is configured to provide a diagnostic specificity of 100% and a positive predictive value of 100% for acute pulmonary thromboembolism, and wherein the diagnostic output unit (110) comprises a user interface (116) configured to display the generated diagnostic indication for acute pulmonary thromboembolism.In one embodiment, the system (100) further comprises a validation unit (116) configured to correlate SRC sign findings with results of pulmonary computed tomography angiography for diagnostic confirmation.The present invention relates to a system for diagnosing acute pulmonary thromboembolisms with an unexpanded pulmonary artery as a diagnostic sign. The proposed diagnostic system of the present invention functions by the coordinated interaction of multiple specialized entities to identify acute pulmonary thromboembolisms from the new SRC sign. The transthoracic echocardiography unit captures comprehensive heart images using standard echocardiography views including the apical four-chamber view for assessment of the right heart and the parasternal short axis view for assessment of the pulmonary artery. The system provides optimum image quality through proper probe positioning and gain optimization to allow accurate measurements. The measurement unit processes the acquired echocardiography images to determine the exact dimensions of the heart structures. To assess the right atrium, the unit calculates the atrial area at the apical four-chamber gaze, with areas above 18 cm 2 indicating dilation. The right ventricle assessment includes several dimension measurements, including the basal diameter above 42 mm, the mean diameter above 35 mm, and the longitudinal dimension above 86 mm for ventricular dilation confirmation. The device also measures the diameter of the main pulmonary artery in the middle between pulmonary valve and bifurcation using the inner edge technique. The comparison unit performs critical diameter analysis by measuring the diameter of the ascending aorta above the sitoubular junction and calculating the ratio between the diameter of the pulmonary artery and the aorta. When this ratio reaches or falls below 1.0, the system identifies a non-expanded pulmonary artery. This comparison eliminates variance due to patient size and provides standardized assessment criteria for different patient populations. The diagnostic sign recognition unit integrates measurements from all heart chambers to identify the SRC sign configuration. The unit confirms the presence of an extended right atrium and an extended right ventricle and simultaneously checks the status of the non-extended pulmonary artery. This unique combination distinguishes acute PTE from chronic right heart diseases where dilation of the pulmonary artery is typically associated with right ventricle enlargement. The recognition unit uses algorithm analyses to ensure consistent character identification among different operators and in different clinical environments. The diagnostic output unit generates comprehensive diagnostic indications based on the presence of SRC characters. Upon detection of the indicia, the system provides a positive indication of acute pulmonary thromboembolism with associated confidence values. The unit correlates the findings with the patient's clinical image and assessment according to the Wells criteria to increase diagnostic reliability. Additional function evaluation units evaluate right ventricular performance by measurements of systolic excision at the tricuspid ring level and fractional area change calculations, and thus provide supplemental diagnostic information. The validation unit ensures diagnostic accuracy by correlating the SRC sign findings with the results of CT pulmonaryis angiography, if available. This correlation mechanism allows for continuous system calibration and performance monitoring.In one embodiment, the system utilizes a novel diagnostic sign, the so-called SRC sign, for rapid and accurate diagnosis of acute PTE. The system is implemented on patients. For the experiment, all consecutive patients were included for 18 years with the diagnosis of acute dyspnea and extended RA and RV, with or without extended MPA in transthoracic echocardiography (TTE), as well as patients suspected of PTE according to the Wells criteria. The diagnostic system is used in clinical environments where patients with acute dyspnea and suspected pulmonary thromboembolism become presented according to the Wells criteria. The patient screening unit identifies suitable candidates using clinical evaluation protocols of emergency recording. The system is integrated with standard clinical evaluation devices, including blood test devices for D dimer analysis and ECG devices for cardiac rhythm evaluation. The system has a pulse oximetry unit for monitoring oxygen saturation during comprehensive diagnostic evaluation. The transthoracic echocardiograph unit utilizes advanced imaging devices for acquiring high resolution cardiac images for dimension analysis. The system interacts with devices for computed tomography pulmonary angiography and a Venendopler device in order to enable comprehensive vessel diagnosis. The diagnostic system processes right atrial and right ventricular expanded patients in the echocardiography study regardless of the size of the main pulmonary artery. The validation unit correlates the results of the SRC signature with the CTPA confirmation results to classify confirmed cases of pulmonary thromboembolisms by severity, including massive, submassive, or low risk according to American Heart Association guidelines. The system provides differential diagnostic functions for PTE-like diseases and can be integrated into standard protocols of the clinical treatment of comorbidities such as hypertension, diabetes mellitus and coronary heart disease.The proposed system of the present invention is for the diagnosis of acute pulmonary thromboembolisms by transthoracic echocardiography (TTE) using a transthoracic echocardiography unit. This unit acquires echocardiograph images from standard views including apical four-chamber and parasternal short axis views. The right atrium (RA) and the right ventricle (RV) are evaluated according to the established American Society of Echocardiography guidelines.The measurement unit is used to extract quantitative parameters from the echocardiographic images. The RA dilation is determined by measuring the RA range at the apical four-chamber view. A RA range of more than 18 cm 2 is considered an indicator of dilation. The RV magnitude is also qualitatively and quantitatively determined according to standard echocardiography guidelines. The measurements are obtained from the apical, RV-focused four-chamber view at the end of the diastolic. RV dilation is detected when the RV diameter at the base exceeds 42 mm, in the middle exceeds 35 mm and in the longitudinal direction exceeds 86 mm. The RV dysfunction is evaluated by a two-dimensional fractional area change (FAC) below 35% and a systolic recursion of the tricuspid ring plane (TAPSE) below 16 mm.The system also comprises a comparison unit for evaluating the dilation of the pulmonary artery (PA). This compares the diameter of the main pulmonary artery (MPA) with that of the proximal ascending aorta. The diameter of the MPA is determined from the parasternal short axis of the right ventricular outflow tract with the aid of the inner edge method in the middle between the pulmonary valve and the bifurcation of the PA. The ascending aorta diameter is measured from the parasternal long axis above the sinotubular transition also by the inner edge method. The comparison unit calculates the ratio between the diameters of the MPA and the ascending aorta. A ratio of 1 or less is classified as non-dilation PA, while a ratio above 1 is indicative of PA dilation.A diagnostic sign recognition unit is incorporated into the system to identify the SRC sign defined by the simultaneous presence of a non-dilatated PA (ratio MPA / aorta diameter ≤ 1) with a dilatated RA and RV. The presence of this specific sign is used as a basis for the diagnostic conclusion of acute pulmonary thromboembolism. To further aid diagnosis, the system contains a pulmonary artery pressure evaluation unit which calculates the pulmonary artery systolic pressure (SPAP) on the basis of the jet velocity in tricuspid insufficiency (TR) recorded at the apical four-chamber view. The SPAP is classified into the following categories: light (35-50 mmHg), medium heavy (50-70 mmHg) and heavy (>70 mmHg). The right ventricular function assessment unit is configured to assess RV function based on parameters such as TAPSE and FAC, thus assisting in the detection of RV dysfunction, which is often associated with pulmonary thromboembolism.The diagnostic output unit is configured to generate and display diagnostic evidence of acute pulmonary thromboembolism upon detection of the SRC sign. The presence of this sign, as determined by the diagnostic sign recognition unit, results in a diagnostic specificity and a positive predictive value of 100% for acute pulmonary thromboembolism. The system also includes a validation unit for correlating the findings of the SRC sign with confirmatory results of computed tomography pulmonaryis angiography (CTPA) performed on all patients except one. For purposes of diagnostic comparison, the patients were divided into two groups: the first group comprised patients with undilatated PA as well as dilatated RA and RV, and the second group comprised patients with dilatated PA, RA and RV. The SRC sign is uniquely associated with the first group, emphasizing its specificity as a diagnostic marker for acute pulmonary thromboembolism.In one embodiment, the system for diagnosing acute pulmonary thromboembolisms comprises a data acquisition module for acquiring relevant patient information and diagnostic results. Demographic information such as age and sex is acquired for all participants. In addition, the system acquires and stores clinical data on companion diseases including, but not limited to, diabetes mellitus, hypertension, coronary artery disease, stroke, deep vein thrombosis, and recent history of surgery. The findings of transthoracic echocardiography (TTE) and pulmonary computed tomography (CTPA) are recorded for each patient. Supplemental diagnostic data, including thrombolysis status, thrombophily profile and ECG evaluation, is also integrated into the data memory of the system and allows comprehensive analysis.For statistical evaluation, in one embodiment, the system integrates a data analysis module that uses statistical tools to evaluate diagnostic relationships and performance metrics. The study results are summarized using descriptive statistics. Continuous variables are represented as averages with the corresponding standard deviations, categorial variables as frequencies and percentages. To examine the relationship between the presence of a non-dilation pulmonary artery and the concurrent dilation of the right atrium and ventricle to diagnose acute pulmonary thromboembolism, the system uses the Chi-Square Test with Yates correction, applying a one-way P-value approach. Diagnostic performance metrics including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) are calculated from standard formulas. A threshold value of P below 0.05 is considered an indicator of the statistical significance of the observed relationships.In total, 41 patients with dyspnea or suspected pulmonary thromboembolism (PTE) were included in the analysis, the majority being male (73.17%). Hypertension proved to be the most common comorbidity. Among the clinical classifications, the submassive PTE was the most common, followed by the massive and minor PTEs. Pulmonary embolism-like diseases such as atrial septum failure, COPD with cor pulmonary and restrictive cardiomyopathy have also been observed.Electrocardiograph analysis revealed sinus tachycardia as the most common anomaly followed by the S1Q1T3 pattern. Thrombolytic therapy, predominantly with tenecteplase, has been carried out in less than half of the cases, mostly in response to hypoxia. In the majority of cases (70.73%), deep vein thrombosis (TVT) of the lower extremities was present, while upper extremity TVT and hypercoagulatable conditions were also reported. In several cases, a more recent surgical procedure has been identified as a contributing risk factor.The findings of transthoracic echocardiography (TTE) showed moderate tricuspid insufficiency in about 44% of the patients, pulmonary arterial hypertension (PAH) in almost 88% and right ventricular dysfunction (RV) in about 27%. Dilation of the right atrium (RA) and right ventricle (RV) occurred in 36 patients. Important is the so-called SRC sign, defined as the undilatated pulmonary artery (PA) in dilatated RA and RV, observed in 22 patients who all have confirmed acute PTE in CTPA. In contrast, acute PTE was confirmed in patients with dilation of all three chambers (RA, RV and PA) only in one case.The SRC sign showed 100% specificity and 92.86% negative predicted value (NPV) for the diagnosis of acute PTE, indicating high diagnostic accuracy and high utility in the exclusion of disease. Moreover, the isolated dilation of RA and RV, regardless of the PA dimension, also showed a high specificity (86.67%) for acute PTE. These results confirm the effectiveness of the SRC sign as a reliable diagnostic indicator.The identification of a non-expanded major pulmonary artery (PA) in conjunction with an expanded right atrium (RA) and right ventricle (RV) is referred to as the SRC sign and represents a novel diagnostic indicator integrated into the system for detecting acute pulmonary thromboembolism (PTE). This diagnostic sign extends the performance of the transthoracic echocardiography based system by providing a specific and implementable criterion for identifying acute PTE, particularly in cases of massive embolism.The integration of the SRC character into the diagnostic workflow represents a valuable supplement to the echocardiography evaluation framework. By identifying acute PTE with high specificity and predictive accuracy, the system supports a more rapid and reliable clinical decision making. While current findings emphasize the diagnostic potential of the SRC sign, another large-scale clinical validation is required to confirm its robustness, clarify the pathophysiological mechanisms involved and explore its utility for acute PTE treatment strategies. The ability of the system to recognize the SRC sign can allow earlier and more accurate diagnosis when suspected of PTE, thus contributing to improved treatment results of this potentially life threatening disease.The drawings and the foregoing description show examples of embodiments. Those skilled in the art will appreciate that one or more of the described elements may well be combined into a single functional element. Alternatively, certain elements may be divided into multiple functional elements. Elements of one embodiment may be added to another embodiment. For example, the order of the processes described herein may be changed and is not limited to the manner described herein. Moreover, the actions of a flow chart need not be performed in the order shown; nor do all actions necessarily need to be performed. Also, actions that are not dependent on other actions may be performed in parallel with the other actions. The scope of the embodiments is by no means limited by these specific examples. Numerous variations, whether or not explicitly stated in the specification, such as differences in structure, dimensions, and material use, are possible. The scope of the embodiments is at least as broad as recited in the following claims.Advantages, other advantages and solutions to problems have been described above with reference to specific embodiments. However, the advantages, merits, solutions to problems and any components that may result in an advantage, merit or solution being introduced or enhanced are not to be understood as critical, required or essential features or components of individual or all claims.REFERENCES100 System For Diagnosing Acute Pulmonary Thromboembolism Using A Non-Dilation Pulmonary Artery As Diagnostic Sign. 102 Transthoracic echocardiography unit 104 Measuring unit 106 Comparing unit 108 Diagnostic mark detecting unit 110 Diagnostic output unit 112 Pulmonary artery pressure judging unit 114 Right ventricle function judging unit 116 User interface

Claims

A system (100) for diagnosing acute pulmonary thromboembolism using a non-expanded pulmonary artery as a diagnostic sign, comprising: a transthoracic echocardiograph unit (102) configured to generate echocardiograph images of heart structures; a measurement unit (104) configured to measure dimensions of the right atrium, the right ventricle, and the main pulmonary artery from the echocardiograph images; a comparison unit (106) configured to compare the diameter of the main pulmonary artery with the diameter of the ascending aorta to determine the dilation status of the pulmonary artery; a diagnostic sign recognition unit (108) configured to identify an SRC sign characterized by the presence of an unexpanded right atrial and right ventricular main pulmonary artery; and a diagnostic output unit (110) configured to generate an acute pulmonary thromboembolism diagnostic indication based on the presence of the SRC sign.The system (100) of claim 1, wherein the transthoracic echocardiograph unit (102) is configured to capture images using standard echocardiograph views including a four-chamber apical view and a short-axis parasternal view.The system (100) of claim 1, wherein the measurement unit (104) is configured to determine dilation of the right atrium when the area of the right atrium exceeds 18 cm 2.The system (100) of claim 1, wherein the measurement unit (104) is configured to determine the dilation of the right ventricle when the diameter of the right ventricle at the base exceeds 42 mm, in the middle exceeds 35 mm, and in the longitudinal direction exceeds 86 mm.The system (100) of claim 1, wherein the comparing unit (106) is configured to calculate a ratio between the diameter of the main pulmonary artery and the diameter of the ascending aorta, wherein a ratio of 1 or less indicates a non-expanded pulmonary artery.The system (100) of claim 1, further comprising a pulmonary artery pressure assessment unit (112) configured to calculate the systolic pulmonary artery pressure from the jet velocity in tricuspid insufficiency.The system (100) according to claim 1, further comprising a right ventricle function assessment unit (114) configured to assess a right ventricle malfunction using systolic excision measurements in the tricuspid ring plane and fractional area change calculations.The system (100) of claim 1, wherein the diagnostic sign detection unit (108) is configured to provide a diagnostic specificity of 100% and a positive predictive value of 100% for acute pulmonary thromboembolism, and wherein the diagnostic output unit (110) comprises a user interface (116) configured to display the generated diagnostic indication for acute pulmonary thromboembolism.The system (100) of claim 1, further comprising a validation unit (116) configured to correlate SRC sign findings with results of pulmonary computed tomography angiography for diagnostic confirmation.

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