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

Abstract

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.

Refining outcome prediction in intermediate‐risk pulmonary embolism: The added value of advanced echocardiographic right ventricular assessment

“…5,6 A recent meta-analysis identified 16 definitions of RV dysfunction among 41 studies of patients with acute PE. 6 Chamber dimensions and tricuspid annular plane systolic excursion (TAPSE), as a marker of RV longitudinal contraction, commonly receive significant attention. 6 The prognostic value of individual parameters of RV dysfunction among hemodynamically stable patients remains controversial.…”

“…6 Chamber dimensions and tricuspid annular plane systolic excursion (TAPSE), as a marker of RV longitudinal contraction, commonly receive significant attention. 6 The prognostic value of individual parameters of RV dysfunction among hemodynamically stable patients remains controversial. In the aforementioned meta-analysis, neither the right ventricular-to-left ventricular (RV/LV) ratio nor TAPSE were associated with mortality in this group.…”

“…In the aforementioned meta-analysis, neither the right ventricular-to-left ventricular (RV/LV) ratio nor TAPSE were associated with mortality in this group. 6 Accordingly, the optimal echocardiographic metrics of risk in PE deserve further exploration.…”

“…While the assessment of RV structure and function plays an important role in the evaluation of the patient with acute PE, echocardiographic indices of RV function are many and heterogenous across studies 5,6 . A recent meta‐analysis identified 16 definitions of RV dysfunction among 41 studies of patients with acute PE 6 .…”

“…While the assessment of RV structure and function plays an important role in the evaluation of the patient with acute PE, echocardiographic indices of RV function are many and heterogenous across studies 5,6 . A recent meta‐analysis identified 16 definitions of RV dysfunction among 41 studies of patients with acute PE 6 . Chamber dimensions and tricuspid annular plane systolic excursion (TAPSE), as a marker of RV longitudinal contraction, commonly receive significant attention 6 .…”