60/60 Echo Sign
Last month we presented Echo in Pulmonary Embolism. One of the echo findings associated with acute pulmonary embolism is the echo 60/60 sign. What is the echo 60/60 sign? This week we will learn the features of the 60/60 sign in echocardiography and its implications with pulmonary embolism.
The 60/60 sign includes BOTH:
Please note that it’s the TR pressure gradient that needs to be < 60 mmHg, NOT the RVSP! I mention this because during my research I found sites, and even YouTube videos, that listed the 60/60 sign as PAT < 60 / RVSP < 60. After additional research (references below) I can confirm that the 60/60 sign involves the PAT and TR gradient. Another interesting note is that European literature uses < 60 while references in the USA use < 60.
The Pulmonary Acceleration time (PAT) is the amount of time between the onset of systolic arterial flow and peak velocity. When the pulmonary resistance is hight the wave form is abnormal. The correct way to measure this is as follows:
The 60/60 sign is not sensitive for diagnosing pulmonary embolus (PE) but it is very specific (94%). Due to some controversy over the subjective nature of the McConnell’s sign, the 60/60 sign, “may be more practical in clinical practice because the criteria are more clear cut” (Lang et al, 2011).
The 60/60 Sign in echocardiography is the presence of BOTH:
This sign is not very sensitive for pulmonary embolism but extremely specific. Other articles related to pulmoanry embolism:
Kurzyna M, Torbicki A, Pruszczyk P. Disturbed right ventricular ejection pattern as a new Doppler echocardiographic sign of acute pulmonary embolism. The American journal of cardiology. 90(5):507-11. 2002. [pubmed]
Lang, R. M., Goldstein, S. A., Kronzon, I., & Khandheria, B. K. (2011). Dynamic echocardiography. St. Louis, MO: Saunders Elsevier.
Torbicki, A., Kurzyna, M., Ciurzynski, M., Pruszczyk, P., Pacho, R., Kuch-Wocial, A. et al.Proximal pulmonary emboli modify right ventricular ejection pattern. Eur Respir J. 1999; 13: 616–621
Kurnicka, Katarzyna et al. Echocardiographic Pattern of Acute Pulmonary Embolism: Analysis of 511 Consecutive Patients. Journal of the American Society of Echocardiography, Volume 29, Issue 9, 907 – 913
Tossavainen, E., Soderberg, S., Gronlund, C., Gonzalez, M., Henein, M., & Lindqvist, P. (2013, January 07). Pulmonary artery acceleration time in identifying pulmonary hypertension patients with raised pulmonary vascular resistance. Retrieved from https://academic.oup.com/ehjcimaging/article/14/9/890/2397468
Torbicki, A. (2005). Echocardiographic diagnosis of pulmonary embolism: A rise and fall of McConnell sign? European Journal of Echocardiography,6(1), 2-3. Retrieved June 4, 2019.
Judith Buckland, MBA, RDCS, FASE