Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: a systematic review

Sanchez, Olivier; Trinquart, Ludovic; Colombet, Isabelle; Durieux, Pierre; Huisman, Menno V.; Châtellier, Gilles; Meyer, Guy

doi:10.1093/eurheartj/ehn208

Cited by 488 publications

(403 citation statements)

References 22 publications

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“…6 In the above-mentioned meta-analysis of two studies (with two different RV/LV ratio thresholds, 1.5 and 1.0) including 191 normotensive patients with PE, a 58% (95% CI, 51---65%) overall negative and a 57% positive (95% CI, 49---64%) value of RV dilatation were reported on MDCT for predicting early death, yielding a relative risk for in-hospital mortality of 2.28 (95% CI, 0.9---5.9). 13 Our study extends these findings to a population of severely ill patients (all with RV/LV ratio >1.0) and demonstrates that patients with RV/LV ratio >1.8 have an 11-fold higher risk of mortality during medium-term follow-up. These results are comparable to those reported by Ghuysen et al, 14 in which patients with a mean RV/LV ratio of 1.52 had a mortality of 25%.…”

Section: Discussionsupporting

confidence: 71%

“…This is reflected by the low mean RV/LV ratios reported in the literature, ranging from 1.1 5,11 to 1.32. 12,13 Moreover, the proportion of patients undergoing thrombolytic therapy in these studies was also low.…”

Section: Introductionmentioning

confidence: 84%

“…At the same time, acute RV dilatation aggravates tricuspid regurgitation, itself worsening RV performance. Several reports 5,6,14,19,20 and a meta-analysis 13 suggest that an RV/LV ratio >1.0 (or 0.9 in reconstructed four-chamber views) is a strong prognostic marker in patients with acute PE. Although there is some evidence that reconstructed four-chamber views may be superior to axial views for the identification of high-risk patients, 19 several studies have found robust prognostic value using standard axial acquisitions to calculate the RV/LV ratio.…”

Section: Discussionmentioning

confidence: 99%

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One-shot diagnostic and prognostic assessment in intermediate- to high-risk acute pulmonary embolism: The role of multidetector computed tomography

Baptista

Santiago²,

Jorge

et al. 2013

Revista Portuguesa de Cardiologia

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Introduction: Contrast-enhanced multidetector computed tomography (MDCT) is useful for the diagnosis of pulmonary embolism (PE). However, current guidelines do not support its use for risk assessment in acute PE patients. Objectives: We compared the prognostic impact of MDCT-derived indices regarding mediumterm mortality in a population of intermediate-to high-risk PE patients, mostly treated by thrombolysis. Methods: Thirty-nine consecutive patients admitted to an intensive care unit with acute PE were studied. All patients had a pulmonary MDCT on admission to the emergency room as part of the diagnostic algorithm. We assessed the following MDCT variables: right ventricular/left ventricular diameter (RV/LV) ratio, arterial obstruction index, pulmonary artery-to-aorta diameter ratio and azygos vein diameter. A 33-month follow-up was performed. Results: Mean age was 59.1±19.6 years, with 80% of patients receiving thrombolysis. Followup all-cause mortality was 12.8%. Of the MDCT-derived variables, only the RV/LV ratio had significant predictive value, being higher in patients who suffered the endpoint (1.6±0.5 vs. 1.9±0.4, p=0.046). Patients with an RV/LV ratio ≥1.8 had 11-fold higher medium-term allcause mortality (3.8% vs. 38.8%, p<0.001). Regarding this endpoint, the c-statistic was 0.78 (95% CI, 0.60---0.96) for RV/LV ratio and calibration was good (goodness-of-fit p=0.594). No other radiological index was predictive of mortality. elsevier.pt, day 19/02/2013. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. 8 R. Baptista et al.Although further studies are needed, the simple-to-calculate RV/LV ratio has good discrimination and calibration for predicting poorer outcomes in patients with acute PE. © 2012 Sociedade Portuguesa de Cardiologia Published by Elsevier España, S.L. All rights reserved. Angiografia pulmonar por tomografia computadorizada em doentes com tromboembolia pumonar de médio a alto risco: avaliação diagnóstica e prognóstica num só exame Resumo Introdução: A angiografia pulmonar por tomografia computadorizada com contraste (angio-TC) é recomendada para o diagnóstico mas não para a estratificação de risco em doentes com tromboembolia pulmonar (TEP). Objectivos: Determinar o impacto prognóstico a médio-prazo de vários índices radiológicos obtidos na angio-TC em doentes com TEP de médio a alto risco, a maioria tratados com fibrinólise. Métodos: Estudaram-se 39 doentes admitidos numa unidade de cuidados intensivos por TEP, todos com angio-TC prévia realizada na urgência e seguiram-se durante 33 meses. Mediram-se as seguintes variáveis: razão entre os diâmetros do ventrículo direito e ventrículo esquerdo (índice VD/VE), índice de obstrução arterial, razão ente os diâmetros da artéria pulmonar e aorta e diâmetro da veia ázigos. Resultados: A idade média foi de 59,1 ± 19,6 anos; 80% dos doentes foram tratados com fibrinólise. Durante o período de seguimento clínico, a mortalidade foi 12,8%. Das variáveis analisadas, apenas o índice VD/...

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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One-shot diagnostic and prognostic assessment in intermediate- to high-risk acute pulmonary embolism: The role of multidetector computed tomography

Baptista

Santiago²,

Jorge

et al. 2013

Revista Portuguesa de Cardiologia

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“…Meta-analysis of five prospective studies of hemodynamically stable PE demonstrated that 44% of patients had RV dysfunction and a higher mortality rate with a sensitivity of 70%, a positive predictive value of 58%, and a negative predictive value of 60% for prediction of mortality [12]. In another study, the prognostic value of echocardiogram in hemodynamically stable PE patients was moderate [13]. In our study, 29% of patients had RV dysfunction, of which about (82%) belonged to long LOS group.…”

Section: Discussionmentioning

confidence: 99%

Predictors of hospital stay in normotensive acute pulmonary embolism: a retrospective pilot study

Mukhtar

Alhafidh

Khalid

et al. 2018

Journal of Community Hospital Internal Medicine Perspectives

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Introduction: The aim of our study is to determine the clinical, biochemical, and imaging factors that affect the duration of hospital stay in patients admitted with normotensive acute pulmonary embolism.Methods: This was a single-center retrospective study conducted in a community hospital in New York metropolitan area for patients admitted from October 2015 to October 2017.Results: A total of 79 patients were included, the mean age was 55.76 (SD = 17.33), 29 cases were males (37%) and 50 cases were females (63%). Among all patients, 17 cases had short length of stay (LOS) (≤2 days) and 62 cases had long LOS (>2 days). There were statistically significant differences in age (p = .041), presence of lung disease (p = .036), number of comorbidities (p = .043), and pulmonary embolism severity index (PESI) scores (original and simplified; p = .002 and .001, respectively). Logistic regression analysis showed that PESI score significantly predicted long LOS (OR 1.067, 95% CI [1.001, 1.137], p = .048). Similarly, sPESI significantly predicted long LOS (OR 0.223, 95% CI [0.050, 0.999], p = .050). Both regression models were adjusted for age, lung disease, and number of comorbidities.Conclusion: Both original and simplified PESI scores were statistically significant predictors of duration of hospital stay. Patients with multiple comorbidities or with chronic lung disease were also likely to have prolonged hospital stay. None of the cardiac biomarkers affected the duration of hospital stay, neither did the presence of right ventricular dysfunction nor treatment modality.

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“…45 A recent meta-analysis has also confirmed this association. 46 Brain natriuretic peptides (BNPs) and N-terminal proBNP (NT-proBNP) are specific markers of stress on ventricular wall. A strong correlation exists between levels of these markers and RV dysfunction assessed by echocardiography.…”

Section: Risk Assessment and Stratificationmentioning

confidence: 99%

Diagnosis and Management of Acute Pulmonary Embolism

Dokwal¹

2014

PULSE

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Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: a systematic review

Abstract: RV dysfunction assessed by CT, echocardiography, or by cardiac biomarkers are all associated with an increased risk of mortality in patients with haemodynamically stable PE. These findings should be interpreted with caution because of the clinical and methodological diversity of studies.

Cited by 488 publications

References 22 publications

One-shot diagnostic and prognostic assessment in intermediate- to high-risk acute pulmonary embolism: The role of multidetector computed tomography

One-shot diagnostic and prognostic assessment in intermediate- to high-risk acute pulmonary embolism: The role of multidetector computed tomography

Predictors of hospital stay in normotensive acute pulmonary embolism: a retrospective pilot study

Diagnosis and Management of Acute Pulmonary Embolism

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