NDLI: The prognostic value of markers of right ventricular dysfunction in pulmonary embolism: a meta-analysis

Content Provider	Springer Nature : BioMed Central
Author	Coutance, Guillaume Cauderlier, Emmanuelle Ehtisham, Javed Hamon, Michèle Hamon, Martial
Abstract	Introduction In pulmonary embolism (PE) without hemodynamic compromise, the prognostic value of right ventricular (RV) dysfunction as measured by echocardiography, computed tomography (CT) or biological (natriuretic peptides) markers has only been assessed in small studies. Methods Databases were searched using the combined medical subject headings for right ventricular dysfunction or right ventricular dilatation with the exploded term acute pulmonary embolism. This retrieved 8 echocardiographic marker based studies (n = 1249), three CT marker based studies (n = 503) and 7 natriuretic peptide based studies (n = 582). A meta-analysis of these data was performed with the primary endpoint of mortality within three months after pulmonary embolism, and a secondary endpoint of overall mortality and morbidity by pulmonary embolism. Results Patients with PE without hemodynamic compromise on admission and the presence of RV dysfunction determined by echocardiography and biological markers were associated with increased short-term mortality (odds ratio (OR) ECHO = 2.36; 95% confidence interval (CI): 1.3-43; OR BNP = 7.7; 95% CI: 2.9-20) while CT was not (ORCT = 1.54-95% CI: 0.7-3.4). However, corresponding pooled negative and positive likelihood ratios independent of death rates were unsatisfactory for clinical usefulness in risk stratification. Conclusions The presence of echocardiographic RV dysfunction or elevated natriuretic peptides is associated with short-term mortality in patients with pulmonary embolism without hemodynamic compromise. In contrast, the prognostic value of RV dilation on CT has yet to be validated in this population. As indicated both by positive and negative likelihood ratios the current prognostic value in clinical practice remains very limited.
Related Links	https://ccforum.biomedcentral.com/counter/pdf/10.1186/cc10119.pdf
Ending Page	10
Page Count	10
Starting Page	1
File Format	HTM / HTML
ISSN	13648535
DOI	10.1186/cc10119
Journal	Critical Care
Issue Number	2
Volume Number	15
Language	English
Publisher	BioMed Central
Publisher Date	2011-03-28
Access Restriction	Open
Subject Keyword	Intensive Critical Care Medicine Emergency Medicine Pulmonary Embolism Right Ventricular Natriuretic Peptide Ventricular Dysfunction Acute Pulmonary Embolism
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine
Journal Impact Factor	8.8/2023
5-Year Journal Impact Factor	10.4/2023

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