Introduction
Materials and methods
Study objectives
Study endpoints
Search strategy
Study eligibility
Data extraction
Data synthesis and statistical analysis
Results
Description of studies
Right ventricular dysfunction as assessed by echocardiography
Author | Study design | Patients, n | Delay | Primary outcome | SAE definition | Follow-up | Mortality, % | RVD definition | RVD, % | HI, n | Thrombolysis, n (%) | Age, years | Male, % | CHF, % | COPD, % |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
TTE | |||||||||||||||
Grifoni, et al. [7] | Prosp | 162 (209a ) | <1 hour | Death | Clinical worsening, death | Hospital | 4 | 1 in A1, A2, B, G, H1 | 40 | 0 (47 excluded) | 10 (5%) | 65 ± 15 | 40 | 14 | 25 |
Kostrubiec, et al. [8] | Prosp | 98 | <24 hours | Death | Death, vasopressor, thrombolysis, CPR | 40 days | 13 | A9 + C or G + H1 | 60 | 0 | 5 (5%) | 63 ± 18 | 38 | 17 | 7 |
Pieralli, et al. [9] | Prosp | 61 | <1 hour | Death | Death, PE recurrence, HI | Hospital | 6.5 | 1 in A1, A2, B, C, G, H2 | 57 | 0 | 6 (10%) | 75 ± 14 | 26 | 0 | 10 |
Jimenez, et al. [10] | Prosp | 214 | <48 hours | Death | Not studied | 30 days | 3 | 1 in A1, A2,C,F | 40 | 0 | NA | NA | 49 | 11.7 | 13 |
Logeart, et al. [11] | Prosp | 67 | <19 hours | Death | Death, thrombolysis, HI | Hospital | 1.5 | 2 in A3, B, C, D2, F | 54 | 0 | 6 (9%) | 64 | 60 | 0 | NA |
Zhu, et al. [12] | Prosp | 468 (520a ) | NA | SAE | Death, thrombolysis, CPR, MV, embolectomy | 14 days | 1 | 2 in : A2 or A6, C, D3, F | 42 | 0 (52 excluded) | NA | 57 ± 14 | 62 | NA | 8 |
Gallota, et al. [13] | Prosp | 90 | <1 hour | SAE | Death, HI | Hospital | 13 | 1 in A5, B | 72 | 0 | NA | 67 ± 18 | 28 | 44 | 11 |
Palmieri, et al. [14] | Prosp | 89 | Admission | SAE | Death, HI | Hospital | 13.5 | A4 + B + C | 54 | 0 | NA | 63 ± 15 | 27 | NA | 10 |
Spiral CT | |||||||||||||||
van der Meer, et al. [15] | Retro | 120 | NA | Death (PE) | Not studied | 3 months | 15 | dRV/dLV >1 | 57.5 | 0 | 0 | 59 ± 18 | 46 | NA | NA |
Moroni [16] | Retro | 226 | NA | Death | Not studied | 3 months | 10.6 | dRV/dLV >1 | 35 | 0 | 0 | 67 ± 17 | 50 | 14 | 6.5 |
Stein, et al. [17] | Retro | 157 | NA | Death | Not studied | 30 days | 2.5 | dRV/dLV >1 | 50 | 0 | 2 (1.3%) | 56 ± 17 | 41 | 0 | 0 |
NT-proBNP | |||||||||||||||
Kostrubiec, et al. [8] | Prosp | 100 | Admission | Death | Death, thrombolysis, CPR, embolectomy, vasopressors | 40 days | 15 | >600 pg/mL | 39 | 0 | 5 | 62 ± 18 | 35 | 17 | 7 |
Pruszczyk, et al. [18] | Prosp | 70 | Admission | Death | Death, thrombolysis, CPR, embolectomy, vasopressors | Hospital | 15.7 | NA | 83.5 | 0 (9 excluded) | 8 | 63 ± 17 | 37 | NA | NA |
Vuilleumier, et al. [21] | Prosp | 146 | Admission | Death | - | 3 months | 3.4 | 300 pg/mL | 60 | 0 | 0 | NA | 42 | NA | 5 |
BNP | |||||||||||||||
Pieralli, et al. [9] | Prosp | 61 | Admission (<1 hour) | Death | Death, HI, PE recurrence | Hospital | 6.5 | >100 pg/mL | 70 | 0 | 6 | 75 ± 14 | 26 | Excluded | 10 |
Logeart, et al. [11] | Prosp | 67 | Admission | Death | Death, thrombolysis, CPR, vasopressors | Hospital | 1.5 | >527 pg/mL | 67 | 0 | 6 | 64 ± 16 | 60 | Excluded | NA |
ten Wolde, et al. [19] | Prosp | 110 | Admission | Death | Not studied | 3 months | 8.2 | >21.7 pmol/L | 33 | 0 | NA | 58 ± 18 | NA | NA | NA |
Tulevski, et al. [20] | Prosp | 28 | Admission (<1 hour) | Death | Not studied | 90 days | 7.1 | >10 pmol/L | 50 | 0 | NA | 53 ± 18 | 43 | Excluded | 0 |
Number of patients | Number of studies | Odds ratio | Sensitivity, % | Specificity, % | PLR | NLR | PPV, % | NPV, % | |
---|---|---|---|---|---|---|---|---|---|
TTE Death all-cause | 1,249 | 8 | 2.36 (1.3-4.3) | 74 (61-84) | 54 (51-56) | 1.4 (1.2-1.6) | 0.62 (0.41-0.92) | 7.6 (5.6-10) | 97.6 (96-98.6) |
TTE PE-related death | 781 | 7 | 4.44 (1.75-11.3) | 92 (78-98) | 51 (48-55) | 1.65 (1.4-2) | 0.36 (0.2-0.8) | 8.4 (6-11) | 99 (98-100) |
TTE SAE | 1,035 | 7 | 4.03 (2.76-5.9) | 77 (71-83) | 58 (54-61) | 1.73 (1.5-1.9) | 0.46 (0.3-0.6) | 30 (26-34) | 92 (89-94) |
CT Death all-cause | 383 | 2 | 1.54 (0.7-3.4) | 46 (27-66) | 59 (54-64) | 1.3 (0.4-2) | 0.8 (0.6-1.2) | 8.3 (4.5-14) | 93 (89-96) |
CT PE-related death | 277 | 2 | 2.17 (0.06-79) | 87.5 (47-100) | 48 (42-54) | 1.2 (0.25-6) | 0.51 (0.007-36) | 5 (2-9) | 99 (96-100) |
CT SAE | 0 | 0 | - | - | - | - | - | - | - |
BNP-ProBNP Death all-cause | 582 | 7 | 7.7 (2.9-20.2) | 96 (86-100) | 42 (38-46) | 1.5 (1.2-1.9) | 0.26 (0.1-0.6) | 13 (10-17) | 99 (97-100) |
BNP-ProBNP PE-related death | 436 | 6 | 6.4 (2-20) | 97 (84-100) | 42 (37-47) | 1.5 (1.2-1.9) | 0.3 (0.1-0.7) | 12 (8-16) | 97 (84-100) |
BNP-ProBNP SAE | 228 | 3 | 15.6 (3-82) | 100 (91-100) | 36 (30-44) | 1.5 (1.3-1.7) | 0.01 (0.02-0.5) | 26 (19-33) | 100 (91-100) |
Right ventricular dysfunction as assessed by computed tomography
Right ventricular dysfunction as assessed by BNP/NT-proBNP elevation
Discussion
Right ventricular dysfunction as assessed by echocardiography
Right ventricular dysfunction as assessed by computed tomography
Right ventricular dysfunction as assessed by BNP or NT-proBNP elevation
Conclusions
Key messages
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Echocardiographic right ventricular (RV) dysfunction or elevated natriuretic peptides are associated with short-term mortality in patients with pulmonary embolism without hemodynamic compromise.
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The prognostic value of RV dilation on computed tomography has yet to be validated in this population.
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As indicated by both positive and negative likelihood ratios, the current prognostic value of RV dysfunction markers remains very limited in clinical practice.