Computed tomography to assess risk of death in acute pulmonary embolism: a meta-analysis

Abstract

The aim of this study was to evaluate whether right ventricle dilation at computed tomography (CT) angiography can be used to assess the risk of death in patients with acute pulmonary embolism.Medline and EMBASE were searched up to April 30, 2013. Studies reporting on the association between right ventricle dilation (right-to-left ventricle diameter) or dysfunction (inter-ventricular septal bowing) at CT angiography and death at 30 days, as well as at 3 months in patients with acute pulmonary embolism, were included in a systematic review and meta-analysis.CT-detected right ventricle dilation was associated with an increased 30 day-mortality in all-comers with pulmonary embolism (OR 2.08 (95% CI 1.63-2.66); p,0.00001) and in haemodynamically stable patients (OR 1.64 (95% CI 1.06-2.52); p50.03), as well as with death due to pulmonary embolism (OR 7.35 (95% CI 3.59-15.09); p,0.00001). An association between right ventricle dilation and 3-month mortality was also observed (OR 4.65 (95% CI 1.79-12.07); p50.002).Right-to-left ventricle dilation as assessed by CT angiography can be used to evaluate risk of death in allcomers with pulmonary embolism and in haemodynamically stable patients. @ERSpublications Multidetector CT can be used to assess short-term risk of death in patients with acute pulmonary embolism

Prospective Randomized Comparison of High-pitch CT at 80 kVp Under Free Breathing with Standard-pitch CT at 100 kVp Under Breath-Hold for Detection of Pulmonary Embolism

“…The reduction of cardiac motion artifacts allowed for a better visualization of cardiac structures such as the heart septum as well as heart morphology overall. This is important because right-to-left ventricle dilation can be used to evaluate risk of death in patients with PE and in hemodynamically stable patients (16,17).…”

Pulmonary embolism: clinical guidelines of European Society of Cardiology (2014).The Task Force of the European Society of Cardiology for diagnosis and management of pulmonary embolism

“…Дис функция ПЖ была самостоятельным фактором прог ноза неблагоприятного исхода госпитализации как в популяции в целом (ОР -3,5; 95% ный ДИ -1,6-7,7; р = 0,002), так и у гемодинамически стабиль ных больных (ОР -3,8; 95% ный ДИ -1,3-10,9; р = 0,007). Эти результаты были еще раз подтвержде ны в недавних публикациях [229,230].…”

Anticoagulant treatment for acute pulmonary embolism: a pathophysiology-based clinical approach

“…The potential for home treatment or short hospitalisation for patients with a low risk of pulmonary embolism needs to be confirmed in further randomised clinical trials. The need for treatment upgrading for patients at intermediate-high risk of death has been only partially shown by randomised clinical trials, as thrombolytic therapy reduces the rate of in-hospital clinical deterioration but not mortality [24][25][26][27][28][29][30][31].…”

“…Right ventricular dilation, as assessed by either echocardiography (OR 2.4, 95% CI 1.3-4.3) or CT (OR 2.08, 95% CI 1.63-2.66), is associated with an increased risk of death [27,28]. Patients with pulmonary embolism and increased levels of biomarkers of myocardial injury, mainly troponin (OR 5.24, 95% CI 3.28-8.38), also have an increased risk for death even in the absence of haemodynamic impairment (OR 5.90, 95% CI 2.68-12.95) [29].…”