Abstract
BackgroundWe investigated whether right ventricular dysfunction (RVD) as assessed by echocardiogram can be used as a prognostic factor in hemodynamically stable patients with acute pulmonary embolism (PE). Short-term mortality has been investigated only in small studies and the results have been controversial.MethodsA PubMed search was conducted using two keywords, “pulmonary embolism” and “echocardiogram”, for articles published between January 1st 1998 and December 31st 2011. Out of 991 articles, after careful review, we found 12 articles that investigated the implications of RVD as assessed by echocardiogram in predicting short-term mortality for hemodynamically stable patients with acute PE. We conducted a meta-analysis of these data to identify whether the presence of RVD increased short-term mortality.ResultsAmong 3283 hemodynamically stable patients with acute PE, 1223 patients (37.3%) had RVD, as assessed by echocardiogram, while 2060 patients (62.7%) had normal right ventricular function. Short-term mortality was reported in 167 (13.7%) out of 1223 patients with RVD and in 134 (6.5%) out of 2060 patients without RVD. Hemodynamically stable patients with acute PE who had RVD as assessed by echocardiogram had a 2.29-fold increase in short-term mortality (odds ratio 2.29, 95% confidence interval 1.61-3.26) compared with patients without RVD.ConclusionsIn hemodynamically stable patients with acute PE, RVD as assessed by echocardiogram increases short-term mortality by 2.29 times. Consideration should be given to obtaining echocardiogram to identify high-risk patients even if they are hemodynamically stable.
Highlights
We investigated whether right ventricular dysfunction (RVD) as assessed by echocardiogram can be used as a prognostic factor in hemodynamically stable patients with acute pulmonary embolism (PE)
Stable patients with acute PE who had RVD as assessed by echocardiogram had a 2.29-fold increase in short-term mortality (Figure 2) (odds ratio (OR) 2.29, 95% confidence interval (CI) 1.61-3.26) compared with patients without RVD
An echocardiogram is more specific to assess right ventricular function because we can directly image the right ventricle with the echocardiogram, which is not influenced by other co-morbidities
Summary
We investigated whether right ventricular dysfunction (RVD) as assessed by echocardiogram can be used as a prognostic factor in hemodynamically stable patients with acute pulmonary embolism (PE). Short-term mortality has been investigated only in small studies and the results have been controversial. Few studies have investigated the prognostic implications of RVD as assessed by echocardiogram in hemodynamically stable patients with acute PE and the results have been controversial. There have been two previous meta-analyses regarding the assessment of RVD by echocardiogram in hemodynamically stable patients with acute PE that revealed increased short-term mortality [4,5]. The clinical impact of RVD as assessed by echocardiogram is still controversial and current venous thromboembolism guidelines do not recommend the routine echocardiogram to assess right ventricular function in hemodynamically stable patients with acute PE [6].
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