60/60 sign (echocardiography)
The 60/60 sign in echocardiography refers to the coexistence of a shorted right ventricular acceleration time with a discordant, low velocity tricuspid regurgitant jet. A finding 94% specific for acute cor pulmonale due to pulmonary embolism, the tricuspid regurgitant (TR) jet will be <60 m/s (and above 30 m/s) and the right ventricular outflow tract (RVOT) acceleration time will be <60 ms 1.
Faced with a chronic elevation in pulmonary arterial pressures, the right heart generates increased pressures; in this context, tricuspid regurgitant velocities (>60 m/s) increase commensurate with increased right ventricular systolic pressure (RVSP) and the RVOT acceleration time decreases as a reflection of increased mean pulmonary arterial pressure (mPAP) 2.
In the setting of acute cor pulmonale, the right heart lacks the capacity to increase pressure proportionate to afterload. The RVOT acceleration time will shorten, but does not reflect a true increase in pressure. Interrogation of the tricuspid regurgitant jet will characteristically reveal a velocity below 60 m/s, confirming the lack of a significant rise in pulmonary artery systolic pressure (sPAP).
- 1. Kurzyna M, Torbicki A, Pruszczyk P, Burakowska B, Fijałkowska A, Kober J, Oniszh K, Kuca P, Tomkowski W, Burakowski J, Wawrzyńska L. Disturbed right ventricular ejection pattern as a new Doppler echocardiographic sign of acute pulmonary embolism. (2002) The American journal of cardiology. 90 (5): 507-11. Pubmed
- 2. Kurnicka K, Lichodziejewska B, Goliszek S, Dzikowska-Diduch O, Zdończyk O, Kozłowska M, Kostrubiec M, Ciurzyński M, Palczewski P, Grudzka K, Krupa M, Koć M, Pruszczyk P. Echocardiographic Pattern of Acute Pulmonary Embolism: Analysis of 511 Consecutive Patients. (2016) Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. 29 (9): 907-13. doi:10.1016/j.echo.2016.05.016 - Pubmed
- 3. Kluetz PG, White CS. Acute pulmonary embolism: imaging in the emergency department. (2006) Radiologic clinics of North America. 44 (2): 259-71, ix. doi:10.1016/j.rcl.2005.10.004 - Pubmed