The McConnell sign on bedside echocardiography: does it provide added value?

Point-of-care ultrasound (POCUS) is particularly important for decision-making in emergency situations. In venous thromboembolic disease, especially pulmonary embolism (PE), it plays a crucial role in risk stratification and treatment decisions. The McConnell sign is recognized as an echocardiographic indicator of PE.

The aim of this study was to evaluate the prognostic value of the McConnell sign.

Patients were analysed from an observational registry within a multidisciplinary response team for PE (PERT), where various catheter-directed therapies (aspiration, fragmentation, local thrombolysis) were employed for intermediate-high and high-risk PE cases with contraindications for systemic thrombolysis.

A total of 117 patients were included from 2017 to 2023. There was a 55% male representation (65 patients). The McConnell sign was present in 34% (40 patients). No statistically significant differences were found in clinical presentation or extent of PE (Table 1). Similarly, no significant differences were noted in systolic blood pressure between patients with and without the McConnell sign (114.3 vs. 114.7, p=0.186), nor in mean pulmonary pressure (35.7 vs. 35.8 mmHg, p=0.24), pulmonary systolic pressure (57 vs. 56.3, p=0.093), or cardiac output (4.04 vs. 3.9 L/min, p=0.11). A statistically significant association was found only with prior heart failure (Table 1).

Our results indicate that the McConnell sign is associated with the presence of heart failure but does not demonstrate other prognostic implications in the course of PE.