Detection of right ventricular dysfunction in acute pulmonary embolism by computed tomography or echocardiography: A systematic review and meta‐analysis

Chornenki, Nicholas L. Jackson; Poorzargar, Khashayar; Shanjer, Maaz; Mbuagbaw, Lawrence; Delluc, Aurélien; Crowther, Mark; Siegal, Deborah

doi:10.1111/jth.15453

Cited by 14 publications

(13 citation statements)

References 46 publications

(124 reference statements)

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“…PPVs and NPVs were suboptimal for the use of echocardiography as a stand-alone test for decision making. Recently, a systematic review and meta-analysis showed that RVD can be detected by computed tomography (CT) imaging; the diagnostic accuracy of CT compared with echocardiography varies depending on specific findings [ 82 ]. The assessment of multiple CT findings of RVD seems to have improved diagnostic accuracy compared to stand-alone findings.…”

Section: Discussionmentioning

confidence: 99%

Prognostic role of different findings at echocardiography in acute pulmonary embolism: a critical review and meta-analysis

Cimini

Candeloro²,

Pływaczewska³

et al. 2022

ERJ Open Res

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BackgroundRight ventricle dysfunction (RVD) at echocardiography predicts mortality in patients with acute pulmonary embolism (PE), but heterogenous definitions of RVD have been used. We performed a meta-analysis to assess the role of different definitions of RVD and of individual parameters of RVD as predictors of death.MethodsA systematic search for studies including patients with confirmed PE reporting on RV assessment at echocardiography and death in the acute phase was performed. The primary study outcome was death in-hospital or at 30 days.ResultsRVD at echocardiography, regardless of its definition, was associated with increased risk of death (RR 1.49, 95%CI 1.24–1.79, I2=64%) and PE-related death (RR 3.77, 95% CI 1.61–8.80, I2=0%) in all-comers with PE, and with death in hemodynamically stable patients (RR 1.52, 95%CI 1.15–2.00, I2=73%). The association with death was confirmed for RVD defined as the presence of at least one criterion or at least two criteria for RV overload. In all-comers with PE, increased RV/LV ratio (RR 1.61, 95% CI 1.90–2.39) and abnormal TAPSE (RR 2.29 CI 1.45–3.59) but not increased RV diameter were associated with death; in hemodynamically stable patients, neither RV/LV ratio (RR 1.11 CI 95% 0.91–1.35) nor TAPSE (RR 2.29, 95% CI 0.97–5.44) were significantly associated with death.ConclusionEchocardiography showing RVD is a useful tool for risk stratification in all-comers with acute PE and in hemodynamically stable patients. The prognostic value of individual parameters of RVD in hemodynamically stable patients remains controversial.

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Section: Discussionmentioning

confidence: 99%

Prognostic role of different findings at echocardiography in acute pulmonary embolism: a critical review and meta-analysis

Cimini

Candeloro²,

Pływaczewska³

et al. 2022

ERJ Open Res

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“…An individual patient-level meta-analysis of 6 prospective cohort studies that included 2874 normotensive patients with PE reported that right ventricular dysfunction was associated with an increased risk of death, shock, or recurrent PE (OR, 2.28 [95% CI, 1.58-3.29) . A systematic review of 21 studies (11 prospective and 10 retrospective) that included 3111 patients reported that compared to the criterion standard of echocardiography, an increased right ventricular:left ventricular ratio greater than 1.0 had a sensitivity of 83% and a specificity of 75% for right ventricular dysfunction . Patients with 1 or more signs of right ventricular dysfunction on imaging and elevated cardiac biomarker (troponin, brain natriuretic peptide [BNP], or N-terminal pro-BNP) are defined as intermediate-high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

“…64 A systematic review of 21 studies (11 prospective and 10 retrospective) that included 3111 patients reported that compared to the criterion standard of echocardiography, an increased right ventricular:left ventricular ratio greater than 1.0 had a sensitivity of 83% and a specificity of 75% for right ventricular dysfunction. 65 Patients with 1 or more signs of right ventricular dysfunction on imaging and elevated cardiac biomarker (troponin, brain natriuretic peptide [BNP], or N-terminal pro-BNP) are defined as intermediate-high-risk patients.…”

Section: Clinical Presentationmentioning

confidence: 99%

Acute Pulmonary Embolism

Freund

Cohen‐Aubart

Bloom

2022

JAMA

102

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ImportancePulmonary embolism (PE) is characterized by occlusion of blood flow in a pulmonary artery, typically due to a thrombus that travels from a vein in a lower limb. The incidence of PE is approximately 60 to 120 per 100 000 people per year. Approximately 60 000 to 100 000 patients die from PE each year in the US.ObservationsPE should be considered in patients presenting with acute chest pain, shortness of breath, or syncope. The diagnosis is determined by chest imaging. In patients with a systolic blood pressure of at least 90 mm Hg, the following 3 steps can be used to evaluate a patient with possible PE: assessment of the clinical probability of PE, D-dimer testing if indicated, and chest imaging if indicated. The clinical probability of PE can be assessed using a structured score or using clinical gestalt. In patients with a probability of PE that is less than 15%, the presence of 8 clinical characteristics (age &lt;50 years, heart rate &lt;100/min, an oxygen saturation level of &gt; 94%, no recent surgery or trauma, no prior venous thromboembolism event, no hemoptysis, no unilateral leg swelling, and no estrogen use) identifies patients at very low risk of PE in whom no further testing is needed. In patients with low or intermediate clinical probability, a D-dimer level of less than 500 ng/mL is associated with a posttest probability of PE less than 1.85%. In these patients, PE can be excluded without chest imaging. A further refinement of D-dimer threshold is possible in patients aged 50 years and older, and in patients with a low likelihood of PE. Patients with a high probability of PE (ie, &gt;40% probability) should undergo chest imaging, and D-dimer testing is not necessary. In patients with PE and a systolic blood pressure of 90 mm Hg or higher, compared with heparin combined with a vitamin K antagonist such as warfarin followed by warfarin alone, direct oral anticoagulants such as apixaban, edoxaban, rivaroxaban, or dabigatran, are noninferior for treating PE and have a 0.6% lower rate of bleeding. In patients with PE and systolic blood pressure lower than 90 mm Hg, systemic thrombolysis is recommended and is associated with an 1.6% absolute reduction of mortality (from 3.9% to 2.3%).Conclusions and RelevanceIn the US, PE affects approximately 370 000 patients per year and may cause approximately 60 000 to 100 000 deaths per year. First-line therapy consists of direct oral anticoagulants such as apixaban, edoxaban, rivaroxaban, or dabigatran, with thrombolysis reserved for patients with systolic blood pressure lower than 90 mm Hg.

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“…In recent years, several studies have focused on evaluating the severity and prognosis of APE based on right ventricular parameters/functions assessed using CTPA. [4][5][6] Several studies have examined atrial parameters in APE 7,8 ; in contrast, left ventricle (LV) parameters have not been studied as extensively. Furthermore, to date, no reports on such evaluations in older patients have been published.…”

mentioning

confidence: 99%

“…Moreover, it has become the first-line imaging method for APE. In recent years, several studies have focused on evaluating the severity and prognosis of APE based on right ventricular parameters/functions assessed using CTPA 4–6 . Several studies have examined atrial parameters in APE 7,8 ; in contrast, left ventricle (LV) parameters have not been studied as extensively.…”

mentioning

confidence: 99%

Alterations and Significance of Computed Tomography Pulmonary Angiography–Derived Parameters in Older Patients With Acute Pulmonary Embolism

Zeng,

Liu,

Xie

et al. 2023

J Comput Assist Tomogr

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Objective This study aimed to investigate changes of computed tomography pulmonary angiography (CTPA)–derived parameters in older adults with acute pulmonary embolism (APE). Methods According to the pulmonary artery obstruction index (PAOI), patients with APE were divided into the A1 (PAOI ≥30%, n = 57) and A2 (PAOI <30%, n = 40) groups. Participants without APE were placed in group B (n = 170). The left atrial (LA) and left ventricular (LV) parameters among the three groups were compared, and the parameter changes in the 44 patients with APE were analyzed before and after treatment. The correlation between APE severity and the parameters was analyzed using correlation analysis. Results The left-to-right diameters (LR) of LA, and LR × anteroposterior diameters (AP) of LA and LV: A1 < A2 < B; LR of LV: A1 < A2, B; AP of LA and LV: A1, A2 < B. After treatment, LR and LR × AP of the LA and LV were significantly increased in the group A1 and LR of the LV and LR × AP of the LA and LV were elevated in the group A2. Acute pulmonary embolism severity was closely associated with LR × AP (r = −0.557) and LR (r = −0.477) of LA. Conclusions With an increase in the degree of obstruction, older adults had a smaller LA and LV. Furthermore, the LR and LR × AP values of the LA were significantly decreased. These results contribute to in-time risk stratification.

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Detection of right ventricular dysfunction in acute pulmonary embolism by computed tomography or echocardiography: A systematic review and meta‐analysis

Cited by 14 publications

References 46 publications

Prognostic role of different findings at echocardiography in acute pulmonary embolism: a critical review and meta-analysis

Prognostic role of different findings at echocardiography in acute pulmonary embolism: a critical review and meta-analysis

Acute Pulmonary Embolism

Alterations and Significance of Computed Tomography Pulmonary Angiography–Derived Parameters in Older Patients With Acute Pulmonary Embolism

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