Computed Tomography-Assessed Right Ventricular Dysfunction And Risk Stratification Of Patients With Acute Non-Massive Pulmonary Embolism: Systematic Review And Meta-Analysis.
J Thromb Haemost. 2013 Aug 22;
Authors: Trujillo-Santos J, den Exter PL, Gómez V, Del Castillo H, Moreno C, van der Hulle T, Huisman MV, Monreal M, Yusen RD, Jiménez D
BACKGROUND: The ability of computed tomographic (CT)-assessed right ventricular dysfunction (RVD) to identify normotensive patients with acute pulmonary embolism (PE) at high risk of mortality or adverse outcome lacks clarity.
METHODS AND RESULTS: We performed a systematic review and a meta-analysis of studies in normotensive patients with acute PE to assess the prognostic value of CT-assessed RVD for death and predefined composite outcome of PE-related complications. We conducted unrestricted searches of Medline and Embase from 1980 through March 2013 and used the terms "computed tomography", "pulmonary embolism", and "prognos*". We used a random-effects model to pool study results; funnel-plot inspection to evaluate for publication bias; and I(2) testing to assess for heterogeneity. The analysis included data from 10 studies (2,288 patients). Overall, 99 of 1,268 patients with RVD assessed by CT died (7.8%; 95% confidence interval [CI], 6.3 to 9.3) compared with 52 of 1,020 without RVD (5.1%; 95% CI, 3.7 to 6.4). CT-assessed RVD had a significant association with mortality (odds ratio [OR], 1.8; 95% CI, 1.3 to 2.6), with death resulting from PE (OR, 7.4; 95% CI, 1.4 to 39.5), and with PE-related complications (OR, 2.4; 95% CI, 1.2 to 4.7). Pooled likelihood ratios (LR) were not extreme (negative LR 0.71; 95% CI, 0.57 to 0.89; and positive LR 1.27; 95% CI, 1.12 to 1.43).
CONCLUSIONS: Although RVD assessed by CT showed an association with an increased risk of mortality in patients with haemodynamically stable PE, it resulted in only small increases in the ability to classify risk. This article is protected by copyright. All rights reserved.
PMID: 23964984 [PubMed - as supplied by publisher]